Anastomotic dehiscence and severe peritonitis

Fifteen years of experience in the management of postoperative complication s following GI surgery are reviewed. In the surgical ICU of the Hopital Sai nt Antoine, Paris, France, a referral center for these conditions, 385 case s of postoperative peritonitis and 500 cases of enterocutaneous fistulas we re observed from 1980 to 1995. Original techniques of management are descri bed in surgical treatment: temporary stomas, intubation and irrigation of l eaks situated on the upper GI tract, primary closure of the abdominal wad w ithout tension, New methods of intensive care of intestinal conditions have also been designed: control and/or obturation of complex enterocutaneous f istulas, reinfusion of chyme into the distal small bowel and continuous ent eral nutrition. In accordance with their experience in this field, the auth ors review the most controversial points of surgical technique and intensiv e care.