Complications of colon surgery

Abstract

T HIS REPORT on complications of colon surgery is based on a modest series. All cases involved private patients in private hospitals without benefit of house staff and all were performed by one group of surgeons. Those of us primarily engaged in the private practice of surgery have been negligent in not reporting our experiences. One gets the inaccurate impression that most surgery is carried out in large combined teaching, charity and private institutions. The house staff plays a major role in the care of the surgically ill. It has been apparent to everyone for many years that impressions of results and complications are usually incorrect. Careful study of personal series may be gratifying or distressing. In either event such analyses are essential to continued improvement in one’s practice of surgery. There has been no selection of cases in this series; every case reported involves a private patient who has undergone colon resection for various diseases of the colon or colotomy for removal of polyp. As complications of surgery usually appear fairly early in the postoperative course, for this part of the study, the follow-up has been 100 per cent. On reviewing the literature, we were gratified to find our complications no greater in number or extent than many reported from our great centers. We were also somewhat disappointed in that they were no less in number or extent. In studying this group of patients it was obvious that colon surgery carries with it certain hazards that are not yet conquered and that further research and study are needed. Research in fields of organ transplants is most glamorous and rather easily supported. However, as the purpose of the medical profession is to do the most good for the most people, more research is indicated in the more mundane fields. There is no questioning the fact that complications of surgery are lessened by training and experience. This does not occur if mistakes are not analyzed and attempts made to correct them. The test of a surgeon is to perform surgery that is indicated, after adequate preparation, in a technically sound manner in order to prevent complications as much as possible. In addition, he must recognize complications early and aggressively and accurately treat them. I have an adage that applies all too often, “When a patient does not do well postoperatively, look first at the operation.” This series of 168 patients includes 114 who had carcinomas, forty who had diverticulitis and fourteen who had other disorders necessitating colon surgery. The miscellaneous group of fourteen is made up of (1) two total colectomies for benign ulcerative colitis; (2) three polypectomies ; (3) two very interesting large lipomas of the cecum. Both of these had been diagnosed as probable carcinoma by the radiologists. (4) One large cecal ulcer with rupture and pericecal abscess. At the time of surgery for this patient, the entire mass was removed as though it were carcinoma without rupturing into the abscess. Her postoperative course was uneventful. The pathologist reported this to be a benign ulcer of the colon with perforation and abscess formation. (5) One adult Hirschsprung’s disease; (6) one