serval:BIB_BBB078E194E6
Emergency right colectomy: which strategy when primary anastomosis is not feasible?
10.1186/s13017-016-0073-6
000377193200002
27148397
Teixeira Farinha
H.
author
Melloul
E.
author
Hahnloser
D.
author
Demartines
N.
author
Hübner
M.
author
article
2016
World Journal of Emergency Surgery
1749-7922
1749-7922
journal
11
19
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.
eng
60_published
true
peer-reviewed
University of Lausanne
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