Indications and Techniques of Digestive Anastomoses at the Hospital in Koutiala District, Mali

Abstract

Purpose: Describe the indications and techniques of digestive anastomoses at the Koutiala District Hospital. Patients and Methods: This was a prospective and descriptive study conducted in the general surgery department of the Koutiala District Hospital. Patients who benefited from digestive anastomosis between the hollow organs of the digestive tract during the period from August 1, 2017 to September 30, 2020 were included. The anastomoses with solid organs were not selected in this study. Results: One hundred and thirty-two patients were registered. Digestive anastomosis accounted for 11.5% of all surgical procedures. The average age was 38.6 years. Men were in the majority with 70.5%. The Karnofsky index was estimated to be less than 50% in 12 patients. Digestive anastomoses were indicated after resection of ileal necrosis in 43 patients (32.6%) followed by tumor resection in 32 patients (24.2%) and typhic perforations in 20 patients (15.1%). There were also 12 cases of digestive stoma (9.1%), 15 cases of volvulus of the sigmoid colon (11.4%), 7 cases of rectal prolapse (5.3%) and 3 cases of Hirschprung’s disease (2.3). Digestive anastomosis was performed in 89 patients in an emergency and was manual in all patients. Post-operative morbidity was 18.9%. These recorded complications, classified grade I (10 cases), grade II (3 cases), grade IIIa (2), grade IIIb (6 cases) and grade IV (4 cases) according to Clavien-Dindo, consisted of 8 cases of postoperative peritonitis (6.1%), 3 cases of external digestive fistula (2.3%), 2 cases of evisceration (1.5%), 12 cases of parietal suppuration (9.1%) and 4 cases of death (3.0%). Conclusion: Young male subjects are the most affected. Anastomoses are performed more often after the removal of the island necroses. Morbi-mortality is high. Success depends on several factors, including the general condition of the patient and the mastery of the anastomosis technique.