Rectal-tube decompression in left colectomy

Summary

A series of 392 patients undergoing anterior resection, in each of whom an indwelling rectal tube was used for anastomotic decompression, was reviewed. Anastomotic complications occurred in 3.8 per cent. Five patients (1.3 per cent) died postoperatively, but only one death resulted from anastomotic leak and sepsis. The need for concomitant colostomy was reduced to 3.8 per cent, obviating the morbidity and potential mortality associated with a colostomy and its subsequent closure. Use of a rectal tube facilitated colostomy closure at the time of resection in five of seven patients who had obstruction, making later colostomy closure unnecessary. The low incidence of anastomotic recurrence (1 per cent) and suture line stenosis (0.5 per cent) demonstrates that an indwelling rectal tube does not predispose to these two complications.

Anastomotic dehiscence is the primary cause of morbidity and mortality associated with surgical procedures involving the left colon. To minimize anastomotic complications, the surgeon must obtain a water-tight anastomosis, without tension, using healthy bowel with a good vascular supply. The use of an indwelling rectal tube is no substitute for fulfillment of basic surgical requirements, but it assures an adequate lumen, reduces suture-line tension, protects blood supply, and provides a means for local antibiotic irrigation.