[Is the protective colostomy in left-sided resections of the colorectum necessary?].

In a prospective clinical study 100 left-side colon and anterior rectum resections were performed without a protective colostomy under standardized conditions: Whole gut lavage, oral and systemic antibiotic prophylaxis, parenteral highcaloric nutrition perioperatively, anastomosing technique end to end, single layer, with atraumatic sutures (3 X 0 Vicryl, Dexon) or EEA stapler. A clinically relevant insufficiency of the anastomosis was seen in 4%, wound-healing impairment in 7%, only one patient died. Due to careful preparation and operation technique the frequency of septic complications and mortality nowadays is very low. On the other side a protective colostomy is afflicted with psychical problems to the patient, higher costs because of the longer period of hospitalization and a not unimportant number of complications of colostomy closure. Therefore we consider the routine usage of protective colostomy as not being necessary in elective colon and anterior rectum resections.