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Category: Volume 05 Issue 10 October 2017
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Title: Primary Bowel Repair with Exteriorization of Anastomosis– A Hospital Based Study

Authors: Mubashar Akram, Abhinav Mani

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i10.145

Abstract

Background: A defunctioning stoma is used primarily to protect the anastomosis and prevent sepsis. However, temporary stoma is a morbid condition in itself affecting quality of life. Exteriorized anastomosis is an alternative in high-risk situations as it avoids intraperitoneal anastomotic leak and the risks of a second procedure.

Aim: 1.To see the feasibility of exteriorized bowel repair as an alternative to stomas i.e.ileostomy and colostomy.2.To evaluate morbidity in terms of duration of hospital stay and complication rate in patients with exteriorized bowel repair as well as mortality, if any.

Design and Place: This is a prospective observational study which was carried out in 30(thirty) patients admitted in Post Graduate Department of Surgery Government Medical College, Jammu over a period of one year w.e.f. November 2012 to October 2013.

Method: 30 patients were subjected to primary bowel repair with exteriorization of anastomosis. ‘Drop-back’ of exteriorized anastomotic segment is done under local or mask anaesthesia if there is no leak from anastomosis. Immediate complications are noted and dealt accordingly.

Result: Of the 30 patients included in our study, there was no need of stoma in 10 patients. In 20 patients due to anastomotic leak, the exteriorized segment functioned as stoma with no intra-abdominal collection.

Conclusion: Exteriorization of primary repair with subsequent delayed return of the repaired bowel to its intra-abdominal location represents an intermediate between primary repair and stoma formation. The procedure lacks the severity of intraperitoneal suture dehiscence and other complications of stoma.

Keywords: Ileostomy, Colostomy, Exteriorization, Anastomosis, Drop-back.

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Corresponding Author

Mubashar Akram

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