Outcome of Exteriorization of the Anastomotic Site in Case of Emergency Bowel Surgery.

Anastomotic leakage followed by septic peritonitis is the most serious complication following intestinal surgery. It has an impact on overall postoperative morbidity and mortality. To prevent the complications of intraperitoneal anastomotic leakage, exteriorization of the anastomosis provides a good alternative. The exteriorized anastomosis can be safely dropped back to the peritoneal cavity after healing in the same hospital admission. If anastomotic leakage occurs, then this exteriorized anastomosis can be converted into an ordinary stoma. The main goal of the present study is to assess the feasibility and to see the outcomes of an exteriorized intestinal anastomosis in emergency bowel surgery. This prospective observational study was carried out in the Department of Surgery, Mymensingh Medical College Hospital, Bangladesh from November 2018 to May 2019. Twenty (20) patients who underwent emergency laparotomy with bowel anastomosis were included in this study. The anastomosis was then exteriorized followed by a drop back to the peritoneal cavity if there was no leak from the anastomosis. Immediate complications were noted and managed accordingly as leaked anastomosis was fashioned as a stoma. The exteriorized anastomosis was successfully dropped back into the peritoneal cavity in 75.0% of cases and was possible between the 6th to 10th postoperative days. Anastomotic leak in the exteriorized segment was seen in 25.0% of patients. No added morbidity or mortality was found in leaked exteriorized anastomosis rather than they were fashioned as an ordinary stoma. One patient underwent re-operation for a pelvic abscess which was usually not related to anastomotic leakage and there was no leak after drop back. The mean hospital stay was up to 11.07th postoperative day (POD), ranging from 8th to 30th postoperative day (POD) after successful drop back of exteriorized anastomosis. But after leaked anastomosis, it was the 18th POD which was more due to prolonged management of wound infection with co-morbidities but not due to leakage-related complications. During the study process 2(10.0%) patients died, one due to ARDS and the other due to severe sepsis with complications of a burst abdomen which was also not related to anastomotic leakage. The procedure of exteriorized gut anastomosis has the advantage of shorter hospital stays and can avoid stoma formation, one-stage surgery and single hospital admission. It does not add any morbidity to the patient but also can early detect anastomotic leakage by direct visualization of the anastomotic site and can be converted to an ordinary stoma. So, exteriorized gut anastomosis can be an alternative to the formation of stoma as well as prevent complications of intra-peritoneal anastomotic leak.