Intraluminal bypass technique using a condom for protection of coloanal anastomosis

Abstract

PURPOSE: Most surgeons carry out temporary diverting colostomy in coloanal anastomosis for mid-rectal or lower-rectal carcinomas. It has been reported that proximal fecal diversion provides no guarantee against anastomotic leaks. Some have proposed the use of the intracolonic bypass tube to prevent anastomotic leakage and colostomy, but colonic necrosis has been reported; it is important to use a safe technique that obviates this. METHODS: The rectum is fully mobilized and transected at the level of the levator diaphragm. The mobilized sigmoid and rectum are resected with their mesenteries, and the prepared distal colon is everted 5 cm using Babcock clamps. The ring of a sterilized condom is then sutured to the mucosa and submucosa of the colon with 4/0 chromic catgut sutures. After completion of coloanal anastomosis, the condom is brought to the exterior, and the mid part is transected. RESULTS: We have used a condom for intraluminal bypass procedures in ten rectal carcinoma patients including five preoperative radiation cases. There was no anastomotic dehiscence, leakage, or colonic necrosis because of a condom. CONCLUSION: We believe that the intraluminal bypass technique using a condom is a very safe, cost-effective, and easily available alternative for coloanal anastomosis.