CLOSED VERSUS OPEN, SINGLE-LAYERED, ANASTOMOSIS — A REVIEW OF 35 ESOPHAGEAL AND 113 LARGE BOWEL CASES

Anastomosis breakdown remains a major threat in digestive surgery, most particularly whenever the esophagus or the large bowel are involved. Aiming to assess the relative role of two different techniques, in this context, a total of 148 anastomoses (January 1973- September 1982) is analysed, 35 involving the esophagus (GROUP A) and 113 the large bowel (GROUP B). On Group A 15 anastomoses (Sub-group Al) were carried Out by a single-layered, open technique and 20 (Sub-group A2) by a single-layered, closed, aseptic method. On Group B open anastomoses were performed in 13 (Sub-group Bl) and the closed method was utilized in 100 (Sub-group B2). The patients were evenly distributed as to age, sex and type of pathology. Statistically significant differences were detected, favouring sub-groups A2 and B2 (closed anastomosis), as of major sepsis secondary to anastomotic leak (p=0.05, p=0.001, respectively), deaths consequent to it (p=0.05, p=0.05, respectively) and Combined sepsis (p=O.O0l, p=0.00l, respectively). There were no wound infections on GROUP A. The wound infection rate, though higher in Sub-group Bi than in Sub-group B2 (15.3 We vs. 5 We) did not reach statistical value. It is concluded that the single-layered, closed anastomotic technique offers, indeed, a definite advantage over the more commonly used open method, not only decreasing the wound infection rate but, most effectively, in diminishing the incidence of major intraperitoneal sepsis, consequent to anastomotic leaks. RESUMO Anastomose num so piano por técnica fechada versus técnica aberta — Revisão de 35 casos esofâgicos e 113 do colon A ruptura anastomótica permanece o problema mais grave em cirurgia digestiva, muito em especial sempre que o esofago ou o colon e recto são partes interessadas. Numa tentativa de avaliar o papel desem penhado por duas técnicas diferentes, neste contexto, analizámos, retrospectivamente, 148 anastomose