Abstract
BackgroundPrimary 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.MethodsThis 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.ResultsOne 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.ConclusionEighty 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.
Highlights
Primary anastomosis is considered the standard strategy after right emergency colectomy
All obstructions in the no-Primary anastomosis (PA) group were due to malignant lesions
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
Summary
Primary anastomosis is considered the standard strategy after right emergency colectomy. These rates grow up to 50 and 10 %, especially if risk factors are present. Procedure-related risk factors other than emergency include intra-operative blood transfusion, surgeon experience, operative duration or operations performed during night-shift [6,7,8]. Safety strategies are useful for emergency procedures if several risk factors are present. For left-sided emergency colonic resections, valuable options are creation of an end colostomy or primary anastomosis with diverting ileostomy [9, 10]. Safety strategies have not been established for emergency right-sided resections. Resection with primary anastomosis remains the standard of care in the emergency setting [11, 12]. Overall morbidity and mortality rates raise the question whether safer strategies are needed
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