Value of ileo-ascending colic end to side anastomosis after ileocaecal resection.

Abstract

Objective: To assess the outcome of end to side Ileo-Ascending Colic anastomosis in patients undergoing emergency and elective Ileo-Caecal resection in non-malignant cases. Study Design: Cross Sectional Descriptive study. Setting: Department of Surgery at Fauji Foundation Hospital Rawalpindi. Period: January, 2018 to December, 2020. Material & Methods: A Total of 40 patients with ileo-caecal benign pathology presenting with generalized peritonitis and intestinal obstruction were studied. All patients underwent laparotomy either in emergency or as planned procedure. After dealing with the primary pathology an end to side ileo-ascending colic anastomosis was performed in all cases. Cases of ileo-caecal disease that required an ileostomy or underwent ileo-transverse colic anastomosis were excluded from the study. Anastomosis was performed in conventional two layers with vicryl 3/0. Variables studied were; indication for surgery, per-operative findings and post-operative complications like anastomotic leakage, surgical site infection, burst abdomen and systemic sepsis. Data was analyzed on SPSS (v 26). Results: There were 30 females (75%) and 10 male patients (25%). Age range was 18-72 years with mean age 43.62 years. Common clinical indication of surgery was intestinal obstruction 11 cases (27.5%) followed by generalized peritonitis 10 cases (25%) and trauma 9 cases (22.5%). Post-operative diagnosis in most patients was ileo-caecal tuberculosis 14 cases (35%) followed by trauma to ileo-caecal region 9 cases (22.5%). Anastomotic leakage occurred in 1 patient (2.5%) who underwent second look laparotomy and re-anastomosis. Surgical site infection occurred in 3 cases (7.5%). There was one fatality (2.5%) due to uncontrolled systemic sepsis. Conclusion: An end to side ileo- ascending colic anastomosis in conventional two layers is a safe and reliable procedure after emergency or planned ileo-caecal resection. It saves the patient from ileostomy, preserves colonic length and avoids formation of blind loop.