> -you have seen soft tubes perforate the rectum and so prefer a RIGID
The statement does not appear to make sense, does it? What I did not say clearly
enough was that even soft tubes can cause problems, and therefore, caution must be
exercised with whatever technique is employed.
> More power to you if you can get away with simply repairing
I really try to individualize each situation. I don't need a leak to do a
colostomy, nor does a leak mandate that I do a colostomy. Repair and/or colostomy
are tools to be used as needed, and the need is determined by the details of the
> Also--we should not take
> nonchalantly the advice of another poster that we can simply do an ostomy
> later if it leaks after closing--a postop leak is a lifethreatening event that
> we should not subject a patient to if it can be helped
I couldn't agree with you more. On every one of the colectomies that I perform, I
receive permission to make an ostomy. I don't hesitate to do so, if I am at all
insecure about the integrity of the anastomsis.
> --I guess I'm just not
> as secure in feeling comfortable with your approach, but I can't argue with
> your success
I know that you've experienced this in practice over the years. What works in your
hands may not be effective in mine, and vice versa. I don't have a good
explanation for this observation, but it may have to do with how confidently a
certain technique is applied.