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Surgical strategies -- anastomosis or stoma, a second look -- when and why?
E Hanisch1, T C Schmandra, A Encke
1Klinik für Allgemein- und Gefässchirurgie, Zentrum der Chirurgie, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt, Germany. E.Hanisch@em.uni-frankfurt.de
Introduction:
The indication for performing a primary anastomosis or an intestinal stoma has to be confirmed or negated for every individual case of intestinal ischemia.
Discussion:
In right-sided colonic emergency, primary anastomosis is possible except when associated with generalized peritonitis. In left-sided colonic ischemia and necrosis, delayed anastomosis is the preferred alternative. In ischemia following surgery for abdominal aortic aneurysms, primary anastomosis is contraindicated. In ischemia of the small bowel, an end-to-end anastomosis should be established whenever possible.
Conclusion:
In the case of intestinal ischemia, a second-look laparotomy is mandatory 24-48 h after initial surgery to ensure bowel viability. This second look should be performed regardless of the patient's postoperative clinical status. Laparoscopy has been successfully used for reexploration in intestinal ischemia, but one has to be aware of the present limitations of experience using this technique.