A Comparative Study of Primary Colonic Repair versus Stoma in Emergency Cases

Abstract

Background: In emergency surgery, management of an enterotomy, either spontaneous or following resection of a bowel segment can be by approximation of cut edges, referred to as primary repair or by exteriorization of the involved segment, referred to as ostomy. Indication of this operation can be a perforated bowel segment (produced as a result of trauma or secondary to an inflammatory process of gut) or a devitalized/redundant segment of bowel requiring resection. Penetrating colon injury or blunt abdominal trauma carries a high risk of a high-risk rate of infectious morbidity. The development of infectious complications is related to the injury severity and haemodynamic status of the patient, not the type of operation performed. Aim of the Work: Comparing the outcome of primary repair versus colon diversion in emergency cases regarding efficacy, safety and usefulness. Patients and Methods: A prospective study on 40 patients undergoing either primary repair of bowel or intestinal stoma formation following emergency laparotomies in the Department of Surgery in El-Hussien and El-Haram Hospitals, which is a big emergency and trauma center and cover large geographic area. All persons will give their informed consent. The people who have the decision in performing and choosing the type of the operation are specialists and consultants (they have the license as decision makers). All patients presented in ER department with colorectal emergencies, included trauma (penetrating, gunshot & blunt), obstruction (malignant & non-malignant) and acute abdomen due to perforation, and need emergent laparotomy confirmed by history, clinical examination and investigations. Results: It included 40 patients divided into three age groups with main age of 31.2 ± 20.1 years old. There were 26 males and 14 females. Etiological causes were trauma 30 patients (75%), benign obstruction 2 patients (5%), malignant obstruction 4 patients (10%) and the acute abdomen 4 patients (10%). Time between injury and admission was less than 8 hours in 28 patients and it was between 9 to 24 hours in 12 patients (30%) and more than 24 hours in 4 patients (10%). Shock defined by systolic blood pressure less than 90 mmHg was present in 7 (17.5 %) patients and non-shocked patients were 33 patients (82.5%). Conclusion: After reviewing many literatures and studies, after this work. We recommend primary repair of the colon in colorectal emergent conditions. Especially injuries and benign obstruction and care must be taken when performing primary repair in cases of malignant obstruction and peritonitis due to non-traumatic colonic perforation (PNTCP). First of all the main indicator for the primary repair is the patient's general condition. Over all the main determine to do primarily repair or to divert is the general condition of the patient.