Emergency right colectomy: which strategy when primary anastomosis is not feasible?

Details

Ressource 1Download: BIB_BBB078E194E6.P001.pdf (450.67 [Ko])
State: Public
Version: author
Serval ID
serval:BIB_BBB078E194E6
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Emergency right colectomy: which strategy when primary anastomosis is not feasible?
Journal
World Journal of Emergency Surgery
Author(s)
Teixeira Farinha H., Melloul E., Hahnloser D., Demartines N., Hübner M.
ISSN
1749-7922 (Electronic)
ISSN-L
1749-7922
Publication state
Published
Issued date
2016
Peer-reviewed
Oui
Volume
11
Pages
19
Language
english
Abstract
BACKGROUND: Primary anastomosis is considered the standard strategy after right emergency colectomy. The present study aimed to evaluate alternative treatment strategies when primary anastomosis is not possible to prevent definitive ostomy.
METHODS: This retrospective study included all consecutive patients who underwent right emergency colectomy between July 2006 and June 2013. Demographics, surgical data, and postoperative outcomes were entered in an anonymized database. Comparative analysis was performed between patients with primary anastomosis (PA group) and those where alternative strategies were employed (no-PA group). Outcomes were 30 days complications rate and rate of bowel continuity restoration.
RESULTS: One hundred forty-eight patients (57 % male) with a median age of 65 years (15-96) were included. One hundred and sixteen patients underwent PA (78 %) and 32 were in the no-PA group (22 %). No-PA group patients had more comorbidities (Carlson comorbidity index >3: 98 % vs. 54, p < 0.001). Major complications rate (Dindo-Clavien III to IV) was 24 % in PA group, 88 % in no-PA group (p < 0.001). The 30-day mortality rate was 6 % (n = 7) in PA group versus 25 % (n = 8) in no-PA group (p = 0.004). Fourteen patients in the no-PA group had a split stoma and 18 had a two-staged procedure. Five patients had continuity restoration after initial split stoma (36 %) compared to 10 after a two-staged procedure (55 %; p = 0.265). Anastomotic leak occurred in 10 patients of the PA group (9 %) versus 0 in the no-PA group, where 15 out of 32 patients (47 %) had continuity restoration.
CONCLUSION: Eighty percent of patients requiring emergency right colectomy were anastomosed primarily. For the remaining a two-staged procedure might facilitate bowel continuity restoration in the long-term.
Pubmed
Web of science
Open Access
Yes
Create date
29/05/2016 14:30
Last modification date
20/08/2019 15:29
Usage data