We have reported our experience with 347 consecutive colon anastomoses in 321 patients seen over an 8 year period. The overall anastomotic failure, mortality, and complication rates were 1.4, 2, and 10 percent, respectively, for the entire series. The complication and death rates were significantly higher in patients whose anastomoses were completed as part of an emergency procedure. Even though various one- and two-layer inverting techniques, suture materials, and staples were used, we could not identify any one method as being clearly superior in preventing anastomotic complications, although the results do suggest that some caution may be appropriate before mechanical stapling devices are universally applied. The results support that adherence to accepted surgical principles of reducing the solid content and fecal flora of the colon prior to operation, insuring an excellent blood supply to both bowel ends, even approximation of the bowel ends with inverting sutures which include the submucosal layer of the bowel, absence of tension, meticulous hemostasis, and avoidance of anastomosis in the presence of peritonitis are the primary means of avoiding dehiscence of colon anastomoses.
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