Primary vs. secondary anastomosis for superior mesenteric arterial occlusion

Superior mesenteric arterial occlusion (SMAO) often requires massive bowel resection. We compared primary anastomosis with open abdominal surgery and secondary anastomosis after enterostomy creation for the management of SMAO.

We retrospectively studied 27 patients who underwent massive bowel resection for SMAO; the patients were divided into 2 groups depending on the operative procedure: primary anastomosis with open abdominal surgery (P group) and secondary anastomosis after enterostomy creation (S group).

The mean duration from the initial operation to final operation (closure of open abdomen or closure of enterostomy) was significantly shorter in the P group (4.6±0.9 days) than in the S group (26.8±9.4 days) (p<0.0001). No disease recurrence was observed in either group; however, 2 patients died of multiple organ failure in the S group.

Primary anastomosis with open abdominal surgery is useful for patients with low acute physiology and chronic health evaluation (APACHE) II scores and secondary anastomosis should be performed in patients with high APACHE II scores. Further, it is important to perform timely enterostomy closure on the basis of precise examination of blood flow in the remnant bowel to avoid deterioration in the patients' quality of life.