Anastomotic dehiscence after anterior resection of rectum and sigmoid

Abstract

SUMMARYI. The incidence of dehiscence of the anastomosis after anterior resection of the sigmoid colon and rectum was studied by digital examination of the rectum, sigmoidoscopy, and radiological examination after a small barium enema in 73 patients who had undergone the operation for carcinoma, villous papilloma, or diverticular disease.2. Dehiscence was detected in 37 (or 51 per cent) of the entire series, in 19 (or 40 per cent) of the 47 cases treated by high anterior resection, and in 18 (or 69 per cent) of the 26 cases submitted to low anterior resection. The dehiscences were usually much more extensive after low resection. The possible reasons for these differences are discussed.3. The effect of other factors on the occurrence of dehiscence was examined :-a. A simultaneous transverse colostomy was performed in 28 of the 68 patients undergoing primary resection. It was used in most cases after low resection, whilst after high resection it was reserved largely for cases with faecal loading. The unfavourable nature of the patients submitted to simultaneous covering colostomy makes it impossible to evaluate the influence of this step on the incidence of dehiscence.b. A preliminary transverse colostomy was established 14-21 days before resection in 5 patients. Three of these cases developed anastomotic dehiscence after the resection, so that clearly an empty distal colon at the time of resection provides no certain guarantee against breakdown of the suture line.c. Preoperative administration of bowel antiseptics in the form of phthalylsulfathiazole and neomycin was associated with a significantly lower rate of dehiscence after high anterior resection, but had no obvious beneficial effect on the incidence of this complication after low resection.4. Though minimal dehiscences, especially after high anterior resection, often pursued an innocuous, subclinical course, major dehiscences endangered the patient's life and prolonged convalescence. There were 2 deaths in this series attributable to dehiscence, a mortality of 2.7 per cent. The mean period in hospital after high anterior resection was 17 days in patients who did not develop dehiscence and 35 days in those who did; and after low anterior resection it was 44 days when dehiscence did not occur and 48 days when it did.WHEN anterior resection with sutured anastomosis was originally advocated by Dixon (1939, 1944), Wangensteen (1945), Waugh and Custer (1945), Mayo and Smith (1948), and Mayo, Lee, and Davis 9* (195 I) for the treatment of certain carcinomas of the rectum and rectosigmoid, one of the fears entertained by many surgeons about this operation was that anastomoses at this level in the intestinal tract might be very liable to leak with resulting serious sepsis. It was, indeed, soon discovered that leakage and infection did sometimes occur after anterior resection, but the incidence of complications from this source was insufficient to prohibit the general adoption of this operation in the cases for which it might be deemed suitable. The precise incidence...

Complicações pós-operatórias das anastomoses colorretais

“…O exame direto da linha anastomótica nem sempre é conclusivo e, antes que as manifestações clínicas se exacerbem, o melhor método de imagem, mesmo quando há a disponibilidade para a tomografia 34 , é o exame radiológico contrastado feito com o contraste iodado, solúvel em água 12,14,34 . As tardias podem ser de dois tipos: as primeiras, cujas ocorrências de fato se estabelecem após o quarto dia do pós-operatório imediato (entre o quarto e oitavo dia), podem ter, logo no início, manifestações clínicas exuberantes, nas quais a gravidade tem muita relação com o nível das anastomoses -são mais graves nas anastomoses confeccionadas acima da reflexão peritoneal do que nas mais baixas -e, as segundas, que são descobertas no final do período do pós-operatório precoce (até o 30º dia) ou as que são diagnosticadas no pós-operatório tardio, com exames de imagem -ultrassonográfico ou tomográfico, subsidiados pelo quadro clínico e achado de exame físico.…”

“…A identificação precoce, com imediato tratamento, fatores essenciais na antecipação da evolução catastrófica da deiscência, preconizada por Goligher et al 12,13 , pode ser obtida por meio de exame radiológico contrastado (enema com gastrografina), feito no pós-operatório imediato. Esses mesmos autores fizeram a demonstração precoce da deiscência num estudo que envolveu 135 pacientes submetidos a ressecções colorretais, por carcinoma ou doença diverticular (84 com anastomoses altas e 51 com anastomoses baixas) 12,13 .…”

“…Esses mesmos autores fizeram a demonstração precoce da deiscência num estudo que envolveu 135 pacientes submetidos a ressecções colorretais, por carcinoma ou doença diverticular (84 com anastomoses altas e 51 com anastomoses baixas) 12,13 . Neste estudo, foram identificadas 65 deiscências (35%), sendo 8% com expressão clínica e 27%, apenas radiológica.…”

Liver cirrhosis on the colonic anastomotic healing in rats

“…Anastomotic dehiscence is a serious complication that occurs after gastrointestinal tract operations 1 and increases morbidity and mortality in patients [2][3][4][5][6][7] . Several technical, local, and systemic factors influence the occurrence of colonic anastomotic dehiscence.…”

Efeito da drenagem abdominal na cicatrização de anastomoses colônicas: estudo experimental em ratos

“…A deiscência anastomótica é a mais grave complicação nas intervenções cirúrgicas do intestino grosso, por estar acompanhada de elevada morbi-mortalidade [1][2][3] . No cólon, particularmente, a ocorrência de deiscência de anastomose tem maior gravidade pela perda de fezes em cavidade peritonial levando a peritonites críticas.…”