Continuing experience with single layer appositional anastomosis in the large bowel

Results of continuing experience with single layer appositional anastomosis of the large bowel during 8 years (1977-84) were extracted from a prospective computerized audit of all abdominal operations under one consultant. After 204 elective operations mortality rate was 1.5 per cent: there were no deaths from anastomotic leakage. The total incidence of wound infection (including late infections) was 2.0 percent. The median duration of postoperative stay was 9.7 days and the mode 8 days. Three clinical anastomotic leaks (total incidence 1.5 per cent) occurred in 140 patients (2.1 per cent) after elective colorectal anastomoses. A restorative anastomosis was made in 86 per cent of patients with rectal carcinoma 6-12 cm from the anus and in 29 per cent with tumours below 6 cm. The overall incidence of a permanent stoma for rectosigmoid carcinoma was 19 per cent. 'Protective colostomy' and anastomotic drains were not used. The safety and applicability of single layer anastomosis in the rectum are compared with those of stapling.