Definitive one-stage emergency large bowel surgery

Abstract

During a 30-month period, 126 operations for emergency large bowel conditions were performed: 57 were for colonic carcinoma, 26 for acute diverticulitis, 14 for colonic ischaemia, 13 for complications of inflammatory bowel disease, and 16 for other conditions. Sixty-eight patients had peritonitis. One hundred and ten patients (87.3 per cent) underwent immediate resection. Of these, 83 (65.9 per cent of the overall group) had colonic resection with primary anastomosis but without a colostomy, 56 of which were left-sided colonic resections. Excluding 9 of the 68 patients with peritonitis, who had a total colectomy, 66 per cent also underwent resection, anastomosis and no colostomy. Total group mortality was 14.3 per cent: 12.7 per cent in the immediate resection group, 9.6 per cent in those with primary anastomosis and no colostomy, 5.2 per cent in the group with peritonitis undergoing resection and anastomosis, and 25 per cent in those having non-resectional surgery. Complications included an overall wound infection rate of 10.3 per cent and a clinical anastomotic leak rate of 7.2 per cent in those who had anastomosis without colostomy. Our results suggest that resection and primary anastomosis can be performed with acceptable morbidity and mortality in a high proportion of cases of emergency large bowel conditions, irrespective of underlying pathology, site of disease or the presence of peritonitis.

With Adequate Supervision, the Grade of the Operating Surgeon is not a Determinant of Outcome for Patients Undergoing Urgent Colorectal Surgery

“…This is important because there is now mounting evidence to show a more positive outcome, especially regarding postoperative quality of life, and no increase in mortality associated with primary anastomosis over Hartmann's procedure. [2][3][4][5] This is the first study in recent times to look at the outcomes of all emergency colorectal surgery as performed at a district general hospital (DGH). Other studies have shown similar results between consultants and HSTs in a wide range of surgical practice (inguinal hernia surgery, and elective colorectal cancer surgery 12 ), but most of these studies have involved intense consultant supervision or have not looked at the implications of supervision.…”

Current Practices in Left-Sided Colonic Emergencies

“…Subtotal colectomy plus ileorectal anastomosis has been proven a reasonable option as well [1, 5]. In addition, segmental resection of the obstructed area followed by a primary anastomosis – without a preliminary intra-operative colonic lavage – has been performed successfully [13, 19, 20]. Has this paradigm shift in the management of colonic obstruction – away from the ‘mandatory’ colostomy towards a single-stage procedure – been translated into US practice or is it only a literature-based phenomenon?…”

Outcome of Temporary Stomas

“…Diversion of the fecal stream by construction of a stoma is still a common procedure in colorectal surgery, despite a trend to avoid stomas, especially in emergency surgery [1, 2]. The construction of a stoma is associated with decreased physical and psychological well-being and decreased quality of life.…”