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Resection and primary anastomosis without diverting ileostomy for left colon emergencies: is it a safe procedure?

Abstract：

INTRODUCTION:Large-bowel obstruction and perforation are still frequently occurring entities for the acute care surgeon. In these cases, Hartmann's procedure is the most commonly used surgical technique. However, recent papers demonstrate that colon resection and primary anastomosis (RPA) in the emergency setting is a safe and feasible procedure. We present our series of left colon resection and primary anastomosis procedures from Torrevieja Hospital (Alicante, Spain), performed without bowel irrigation or a diverting ileostomy. MATERIALS AND METHODS:Thirty-two RPA procedures were performed in emergency settings for perforation or obstruction, or both, during an 18-month period. The following data were prospectively collected: age, gender, nationality, diagnoses, ASA score, body mass index (BMI), POSSUM score (Physiological and Operative Severity Score for the enumeration of Mortality and morbidity), and the score according to the Hinchey classification. Furthermore, duration of the operation, length of postoperative hospital stay, and mortality and morbidity data were recorded. RESULTS:Sixteen of these patients were diagnosed with acute diverticulitis, 14 patients with neoplasm (of which 9 cases had obstruction, 2 cases had perforation, and 3 cases had both), and foreign body perforation in the remaining 2 cases. The mean hospital stay was 7.8 (range, 4-10) days. The physiological POSSUM score was 24.4 (range, 15-39), and the surgical POSSUM score was 19.8 (range, 16-24). None of the patients died (0% mortality). Seven patients developed some kind of complication (21.9%), all of which were managed conservatively. CONCLUSIONS:The results of this study suggest that RPA for left colon obstruction and perforation in emergency settings can be safely performed in certain surgical conditions.

journal_name

World J Surg

journal_title

World journal of surgery

authors

Jiménez Fuertes M,Costa Navarro D

doi

10.1007/s00268-012-1513-4

subject

Has Abstract

pub_date

2012-05-01 00:00:00

pages

1148-53

issue

eissn

0364-2313

issn

1432-2323

journal_volume

pub_type

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Resection and primary anastomosis without diverting ileostomy for left colon emergencies: is it a safe procedure?