[Secure anastomoses of the large intestine (especially with transanal drainage]

The results of colonic resections were investigated in 356 patients in a retrospective analysis. Special attention was directed to the effectiveness of a transrectal tube, leading to decompression of the anastomosis for the first five days. Under elective conditions, the overall complication-rate was 12.7%. In emergency cases, these complications were 51.5% (one third of these cases had a decompression-tube). The clinical relevant leakage-rate under elective conditions ranged to 1.7%. Postoperative mortality related to surgical complications turned out to be 1.5% under elective conditions. The emergency operations had a high mortality which ranged to approximately 15.2%. No patient with leakage of a colorectal anastomosis died when the transrectal decompression-tube was applied. Such a safety in anastomotic healing of colon and rectum anastomoses can otherwise only be achieved by using the protection of a diverting colostomy or ileostomy. The use of the transrectal decompression-tube also avoids stomal complications and the second operation. There is no indication for the decompression-tube in emergency operations with purulent or faecal peritonitis. In these cases a fundamentally different treatment is mandatory.