Early stoma closure in colorectal resections after endoscopic monitoring of the anastomosis. Clinical results]

The need for a protection of a colo-colonic or colorectal anastomosis (by a colostomy or ileostomy) does not always encounter a general consensus except in selected clinical settings such as a low or ultra-low colorectal anastomosis or a colo-colonic or colorectal anastomosis after resection for acute disease. Commonly, a protective stoma is closed within 3-6 months after x-ray or endoscopic monitoring of the anastomosis. We believe in the importance of an open debate on the timing of bowel reconstruction and on the ways of monitoring the anastomosis. The aim of our study was to confirm the feasibility of early closure of stomas without specific increased risks, and especially to demonstrate the usefulness of early endoscopic monitoring of the anastomosis. We present 26 consecutive patients who underwent a left colonic resection or a colorectal resection with a stoma constructed for protection. In these patients the early restoration of bowel continuity was achieved between postoperative days 8 and 15 after endoscopic monitoring. There have been no specific complications related to the endoscopic manoeuvre. The morbidity rate after early bowel continuity restoration was 4.1%, which is lower than the rates encountered in the literature (6-8.6%). We consider as innovative the concept of early endoscopic monitoring, which is commonly not indicated in the presence of a recent anastomosis. We believe that in selected conditions the risk of perforation due to this manoeuvre can be eliminated.