PROSPECTIVE-STUDY OF HAND-SUTURED ANASTOMOSIS AFTER COLORECTAL RESECTION

A total of 370 patients underwent colorectal resection: 320 had a prim ary single-layer seromucosal anastomosis without a protective colostom y, 22 had Hartmann's procedure and 28 abdominoperineal resection. Ther e were 260 elective procedures and 110 patients had peritonitis and/or bowel obstruction at the time of surgery. Overall the mortality rate was 2.7 per cent, the morbidity rate was 18.3 per cent and clinical an astomotic leak rate 3.4 per cent. After elective operation, the leak r ate for intraperitoneal anastomosis was 0.6 per cent and for low extra peritoneal anastomosis 7 per cent. The mortality rate was 1.2 per cent and morbidity rate 11.9 per cent. Patients with peritonitis had a sig nificant increase in morbidity rate (46 per cent) in comparison with t hose having elective surgery (chi(2) = 31.5, 1 d.f., P<0.0001). Patien ts who had bowel obstruction and no bowel preparation had a significan tly higher morbidity rate of 26 per cent and mortality rate of 7 per c ent, compared with those having an elective procedure (chi(2) = 11.2, 1 d.f., P<0.001; chi(2) = 8.7, 1 d.f., P<0.005 respectively). Patients having palliative surgery had the highest mortality rate (19 per cent ), compared with those operated on with curative intent (1.5 per cent) (chi(2) = 28.7, 1 d.f., P<0.0001). Cost-saving hand-sutured anastomos is is effective and, in experienced hands, technically feasible after all kinds of colorectal resection and should remain the standard in co lorectal surgery.