Enterorectal and colorectal anastomosis. Evaluation of techniques including midtransverse or left-sided colon tube colostomy and pelvic drainage.

One-stage rectal anastomoses performed in 235 patients by one surgeon were studied. Of numerous techniques used to reduce anastomotic leakage, active suction drainage to remove presacral-space fluid accumulation was the most effective. Leakage developed in 11 (6.9%) of 160 patients whose conditions were managed without suction drainage or transverse or descending colon tube colostomy. In only one (1.1%) of 89 patients treated by one or both modalities did a leak develop. Seventy-two patients receiving suction drainage or both modalities had no leakage. Recorded suction drainage amounts and absence of leakage in these 72 patients support the contention that infected presacral accumulations of fluid are the most important cause of postoperative anastomotic dehiscence after rectal anastomosis. In 71 patients receiving tube colostomy, the tube site closed spontaneously following tube removal. No deaths from leakage occurred in either group.