Posterior Wall Colon Half Anastomosis for Fecal Diversion; a Pilot Prospective Study

Background: Colonic diversion is a common procedure in the practice of colo-rectal surgery; whether on emergent or elective basis. This “diversion”, taking place after colon resection when primary anastomosis is “risky”, takes one of two forms i.e divided or loop form. We introduced a modification for the double-barrel colostomy technique into a hand-sewn loop colostomy at the two divided ends achieving fecal diversion and at the same time assessing the healing power in the patient during the initial operation.
Patients and method: Fifty patients, candidate for fecal diversion after right colonic resection, having different risk factors for anastomotic leakage, were recruited. A posterior wall half colonic anastomosis was done between both resection ends before exteriorization in those patients instead of performing an ileostomy and a mucus fistula. 
Patients, then, completed their treatment plan for the primary pathology and their stomas were closed lately as “a loop” ileocolostomy without the need for re-laparotomy.
Results: All patients (with the except of one patient) had uneventful postoperative course following fecal diversion using the “hand-sewn loop” technique as regards bowl viability and fixation with all the patients being lately closed successfully without the need for re-laparotomy.
Conclusion: Performing a posterior wall half-anastomosis at the initial operation of fecal diversion is a feasible option for patients undergoing fecal diversion after partial colonic resection, helping to avoid morbidities encountered during the operation of restoration of bowl continuity while, simultaneously, testing for hidden risks for anastomotic leakage.