THE ANASTOMOTIC STOMA - A USEFUL PROCEDURE IN EMERGENCY BOWEL SURGERY

In emergency surgery of the bowel a primary anastomosis may be risky. Discontinuing colostomies have the disadvantage that a secondary lapar otomy is necessary to restore continuity. If sufficient bowel loop mob ilization is possible, we prefer to perform an anastomotic stoma. Afte r resection of the diseased bowel segment, we bring the proximal and d istal loop together and proceed to the anastomosis of the posterior wa ll. The anterior wall of the anastomosis remains open and is then fixe d to the abdominal wall as a stoma. So far, we have used this method i n 91 patients. In 73 cases this technique was performed during emergen cy operations. No patient died as a result of complications of the met hod; 21 patients, however, died as a consequence of their primary dise ase. Bowel continuity could be restored in 78 cases. The anastomotic s toma protects the posterior wall from elevated pressure and allows dai ly control of the anastomosis. In the case of extraperitoneal closure, a secondary laparotomy for reconstruction of the continuity is not ne cessary. The anastomotic stoma can be performed in most regions of the small and large bowel.