Anastomotic dehiscence after anterior resection of rectum and sigmoid

Abstract

Abstract 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. 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. The effect of other factors on the occurrence of dehiscence was examined:— 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.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.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. 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.