Anterior anastomosis of the rectosigmoid colon: an experimental study

Leakage in anastomoses below the peritoneal reflection after resection of the upper rectum and lower sigmoid colon has been studied in an experimental model in the dog. With blood alone or with blood and E. coli in the pelvis about the anastomosis, there was no significant increase in the frequency of leakage. With dead space about the anastomosis created by removal of pelvic fat and anterior tacking of the prostate and urinary bladder to the abdominal wall to simulate the human subject with a wide removal of intestine, mesentery, and pelvic fat for carcinoma, there was a high incidence of leakage. When the dead space about the anastomosis was filled with a pedicle graft of viable omentum, there was a significant decrease in the incidence of leakage. In this model dead space about the low anastomosis limiting contact with viable tissue that could adhere to, seal off, and finally revascularize the endangered intestine seemed to be a major cause of leakage. A pedicle graft of viable omentum that filled the dead space reduced the chance of leakage.