Leakage prevention of entero-colonic anastomoses in emergency surgery

The problem of entero-colonic anastomosis leakage in emergency surgery has always been under close medical community attention. The more proximal intestinal sutures are located, the more severe the consequences are. In case of a left half of the colon the solution of the problem is relatively safe colostomy. Treating a patient with entero-colonic anastomosis leakage, the question arises about the ileostomy, which leads to more serious consequences (water-electrolyte disbalance). Most of these patients get treatment for complicated colon cancer, which worsens the prognosis. In general, the risk of entero-colonic anastomosis leakage in emergency surgery reaches 12.7%. The risks are: inadequate assessment of blood fl ow in the suture line, peritonitis, diabetes, smoking, severe ileus, intraoperative blood transfusion, a small experience of a surgeon in performing these operations. Nowadays there are many ways to prevent anastomosis leakage. They are: application of compression devices of Ni-Ti with simultaneous U-shaped ileostomy, biodegradable rings, consolidation of intestinal sutures with «TachoComb» biopolymer substance application, various adhesive compositions, gland. Oblique intersection of the intestinal wall also uses to increase blood fl ow on the suture line, correction of infusion therapy is discussed with inclusion of hydroxyethyl starch. However, the zero frequency of the leakage in the clinic still cannot be achieved. Accordingly, nowadays, the problem of optimal entero-colonic anastomosis technique remains open. It should meet the following requirements: ideally, a zero frequency of leakage; a technical simplicity of the operation; preferably, without using expensive materials; as far as possible — a valve to prevent refl ux ileitis.