Chapter 21 Enterectomy
INTRODUCTION
The reported leak rates for intestinal anastomosis range from 1% to 8%.1–6 Specific leak rates for enterectomy are more difficult to find in the literature. One review reported a 1.1% leak rate in 798 patients undergoing enterectomy.7
The primary aspects necessary for construction of a successful anastomosis include careful approximation of wellvascularized bowel wall in a tension-free manner. Clearly, a technically inadequate anastomosis will lead to anastomotic failure.8 However, despite a technically suitable anastomosis, complications such as anastomotic failure can occur. Significant efforts have focused on understanding the nontechnical factors that contribute to anastomotic failure. Poor nutrition, hypoalbuminemia, infection, smoking, diabetes, obesity, and many others have been implicated in various studies.1–4,7,9–11 Despite extensive investigation, study results are conflicting and no consensus on predisposing factors has been reached. In Pickleman and coworkers’ review,7 the only factor predicting anastomotic leak after enterectomy was hypertension. How this contributed to anastomotic failure was unclear from this study. No differences were seen in stapled versus sewn anastomoses or between different types of anastomoses. Overall, their findings reinforced the concept that a clear set of factors predisposing to anastomotic leak have not been delineated.
OPERATIVE PROCEDURE
Incision
Injuries upon Entry into the Peritoneal Cavity
All grades of injuries can occur during this step. This is primarily the case during reoperative surgery or during a primary procedure when the bowel is grossly dilated. Careful dissection and controlled entry into the peritoneal cavity under these conditions are required to avoid entry complications, as discussed in Section I, Chapters 6 and 7.
Evaluation of the Small Bowel
Missed Lesions
• Consequence
• Prevention
Identification of Transection Sites Proximal and Distal to the Diseased Segment
Creation of the Anastomosis
Injuries during Creation of a Mesenteric Defect
Injury to the small bowel or the adjacent mesentery can occur during this step.
• Consequence
• Prevention
![image](https://i0.wp.com/basicmedicalkey.com/wp-content/uploads/2017/06/B978141602951950030X_gr3.jpg?w=960)
Figure 21-3 Wound contamination is minimized by covering the wound edges with a saline-moistened towel. This and the strategies shown in Figures 21-1 and 21-4 limit enteric spillage and contamination.
Difficulties during Bowel Transection
Complications at this step usually are the result of device malfunction.
• Consequence
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