Failure of the unopened colostomy to protect high-risk rectal anastomoses

Abstract

Anastomotic breakdown, the most serious complication of restorative rectal resection, is responsible for half the postoperative morbidity rate and one‐third of deaths1. While many surgeons defunction low anastomoses2, others consider this unnecessary3. A tube caecostomy can be used after on‐table orthograde bowel lavage to avoid a stoma4. An obstructing unopened loop ‘colostomy’ offers potential advantages5. It can be returned to the abdomen if the anastomosis heals soundly or opened into a colostomy if it leaks. This method was evaluated in seven patients.

The unopened loop ileostomy

“…The proposed advantages of this technique were: (i) easy opening of the loop if diversion is required, or simple reduction if not; (ii) no risk of leakage following replacement as the bowel is not opened; and (iii) less psychological disturbance associated with the stoma. Few reports of this procedure have appeared in the literature, although Dixon & Thomson claim that this method fails to protect high risk rectal anastomoses because of delayed anastomotic dehiscence occurring after the return of the colonic loop to the abdominal cavity, and rod erosion of the loop [ 5].…”