The anastomotic stoma: a useful procedure in emergency bowel surgery

In emergency surgery of the bowel a primary anastomosis may be risky. Discontinuing colostomies have the disadvantage that a secondary laparotomy is necessary to restore continuity. If sufficient bowel loop mobilization is possible, we prefer to perform an anastomotic stoma. After resection of the diseased bowel segment, we bring the proximal and distal loop together and proceed to the anastomosis of the posterior wall. The anterior wall of the anastomosis remains open and is then fixed to the abdominal wall as a stoma. So far, we have used this method in 91 patients. In 73 cases this technique was performed during emergency operations. No patient died as a result of complications of the method: 21 patients, however, died as a consequence of their primary disease. Bowel continuity could be restored in 78 cases. The anastomotic stoma protects the posterior wall from elevated pressure and allows daily control of the anastomosis. In the case of extraperitoneal closure, a secondary laparotomy for reconstruction of the continuity is not necessary. The anastomotic stoma can be performed in most regions of the small and large bowel.