Anastomic dehiscence and severe peritonitis.

Fifteen years of experience in the management of postoperative complications following GI surgery are reviewed. In the surgical ICU of the Hôpital Saint Antoine, Paris, France, a referral center for these conditions, 385 cases of postoperative peritonitis and 500 cases of enterocutaneous fistulas were observed from 1980 to 1995. Original techniques of management are described in surgical treatment: temporary stomas, intubation irrigation of leaks situated on the upper GI tract, primary closure of the abdominal wall without tension. New methods of intensive care of intestinal conditions have also been designed: control and/or obturation of complex enterocutaneous fistulas, reinfusion of chyme into the distal small bowel and continuous enteral nutrition. In accordance with their experience in this field, the authors review the most controversial points of surgical technique and intensive care.