A preliminary report on the intracolonic bypass as an alternative to a temporary colostomy

Abstract

Anastomotic leakage remains the most important cause of morbidity and mortality in colonic operations, and the considerable complication rate accompanying the construction and closure of colostomy to prevent this has prompted an experimental study designed to protect the colonic anastomosis and dehiscence by an intraluminal bypass graft. To accomplish this, a specially prepared soft tube conducts the fecal flow and gastrointestinal secretions from the proximal part of the colon to the distal part of the colon or rectum, preventing any contact with the anastomotic site. Even in the face of surgically created gross colonic anastomotic dehiscences, these dehiscences have progressed to complete healing. The graft is expelled spontaneously after a varying time. A clinical study was therefore instituted. In ten patients in whom temporary colostomies would have been performed with or without a resection at the time, a one stage primary resection and anastomosis with the insertion of an intracolonic bypass graft was carried out. Preliminary clinical results indicate that one procedure could obviate the necessity for construction and subsequent closure of a temporary colostomy avoiding the morbidity and mortality and the considerable economic implications associated with these procedures. Clinical results have paralleled the experimental one. Since this article was accepted for publication, another 25 patients have undergone an intracolonic bypass procedure. Results have paralleled the previous ones except for one patient with fecal impaction at the fifth postoperative week. The separated tube formed part of the impacted fecal mass.