A comparative radiographic study of low anterior colon anastomoses in dogs.

A radiographic animal study comparing two-layer and hand-sewn colorectal anastomoses to anastomoses made with an inverting circular stapling device revealed a highly significant difference in anastomotic leak rate: 13 anastomotic dehiscences were demonstrated in 20 dogs with hand-sewn anastomosis (65%), and four leaks (20%) were found in 20 dogs with stapled anastomoses. All leaks occurred between the third and seventh postoperative days and most were not clinically significant. A marginally significant difference in mortality rate was found, with four deaths among the hand-sewn group (20%) and two among the stapled group (10%). The data suggest that the EEA stapling device may be preferable to hand-sewn techniques, particularly for low extraperitoneal colorectal anastomoses.

Mallory-Weiss syndrome: analysis of fifty-nine cases.

Fifty-nine patients with Mallory-Weiss gastroesophageal lacerations are described. These patients consisted of 6% of all cases of upper gastrointestinal tract hemorrhage we evaluated. The most common symptoms were hematemesis (92%) and retching (61%). A history of chronic alcoholism was present in 69.5%, and recent binge drinking in 52.5% of our patients. Diagnosis was made endoscopically (55 patients) or surgically (four patients). Two deaths occurred in the 51 patients who were managed nonoperatively and two deaths occurred in the eight patients who underwent surgery. None of the deaths was related to delay in operative treatment. Eleven patients had late rebleeding, but in only three of these patients was this due to recurrent Mallory-Weiss lesions. We believe the Mallory-Weiss laceration can now be considered to be a relatively benign condition that can be managed successfully by nonoperative means in the majority of cases.