Outcome of resection and primary anastomosis of colon upto the level of the rectosigmoid junction without diverting ileostomy or colostomy in Dhaka Medical College Hospital-a study of 50+ cases
DOI:
https://doi.org/10.18203/2349-2902.isj20252273Keywords:
Bowel viability, Colonic obstruction, Diversion avoidance, Primary anastomosis, Sigmoid volvulusAbstract
Background: Colon resection is frequently performed in surgical practice for various indications. A key decision is whether to perform primary anastomosis with or without proximal diversion. Although diversion adds safety, it also introduces additional complications. In Bangladesh, outcomes of primary anastomosis without diversion have not been systematically studied. To evaluate the outcomes and safety of colon resection with primary anastomosis, without diverting ileostomy or colostomy, in both emergency and elective surgical cases.
Methods: This descriptive cross-sectional study included 52 patients who underwent colon resection up to the rectosigmoid junction with primary anastomosis, without diversion, in the Department of Surgery, Dhaka Medical College Hospital, from January 2013 to September 2013. Patients over 12 years of age, regardless of sex, meeting specific inclusion and exclusion criteria were enrolled. Data on demographic profile, surgical indication, intraoperative findings, postoperative outcomes and complications were collected and analyzed using SPSS.
Results: Among the 52 patients (age range: 19–75 years), the majority were male (75%) and over 50 years of age. The most common indication for surgery was sigmoid volvulus. Emergency colectomy was performed in 53.85% of cases. In 86.54% of cases, the resected bowel was viable and single-layer anastomosis was the preferred technique. Postoperative blood transfusion was frequently required. Early oral intake was resumed in 55.77% of patients. There was no mortality and 82.69% of patients experienced no postoperative complications. Most patients were discharged within 13–14 days.
Conclusions: This study demonstrates that resection with primary anastomosis of the colon up to the rectosigmoid junction without a diverting ileostomy or colostomy is a safe and effective option in both elective and emergency surgical settings when proper patient selection and operative techniques are employed.
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References
Cotlar AM. Historical landmarks in operations on the colon—surgeons courageous. J Surg Educ. 2002;59(1):91–5. DOI: https://doi.org/10.1016/S0149-7944(01)00606-7
Ostrow B. When is primary anastomosis safe in the colon. Ann African Surg. 2007;1:58. DOI: https://doi.org/10.4314/aas.v1i1.45796
Dudley HA. The history of colostomy in childhood. Pediatr Surg Int. 1990;5(6):368–72.
Jimenez FM, Costa ND. Resection and primary anastomosis without diverting ileostomy for left colon emergencies: is it a safe procedure. World J Surg. 2012;36(5):1148–53. DOI: https://doi.org/10.1007/s00268-012-1513-4
Mohammad N, Khan IA. Resection and primary anastomosis in the management of acute sigmoid volvulus. Pakistan J Surg. 2008;24(2):95–7.
Oberkofler CE, Rickenbacher A, Raptis DA, Lehmann K, Beldi G, Gloor B, et al. A multicenter randomized clinical trial of primary anastomosis or Hartmann’s procedure for perforated left colonic diverticulitis with purulent or fecal peritonitis. Ann Surg. 2012;256(5):819–27. DOI: https://doi.org/10.1097/SLA.0b013e31827324ba
Salem L, Flum DR. Primary anastomosis or Hartmann’s procedure for patients with diverticular peritonitis? A systematic review. Dis Colon Rectum. 2004;47(11):1953–64. DOI: https://doi.org/10.1007/s10350-004-0701-1
Bridoux V, Regimbeau JM, Ouaissi M, Pocard M, Nouira M, Lermite E, et al. Hartmann's procedure vs primary anastomosis for generalized peritonitis due to perforated diverticulitis. JAMA Surg. 2017;152(3):233–40.
Kuzu MA. Emergency colorectal surgery in the elderly: Risk factors and outcome. Int J Colorectal Dis. 2006;21(2):124–30.
Ohmori T. Role of aging in the development of sigmoid volvulus: A multivariate analysis. J Gastroenterol Hepatol. 2008;23(11):1801–5.
Ballantyne GH. Review of sigmoid volvulus: History and results of treatment. Dis Colon Rectum. 1982;25(6):494–501. DOI: https://doi.org/10.1007/BF02553666
Oren D. Changing trends in the management of sigmoid volvulus: 25 years’ experience. Dis Colon Rectum. 2007;50(3):489–95. DOI: https://doi.org/10.1007/s10350-006-0821-x
Farid M. Impact of BMI on surgical outcomes in emergency colectomy. World J Surg. 2009;33(4):866–71.
Halabi WJ. Colonic volvulus in the United States: Trends and outcomes. Arch Surg. 2010;145(3):263-8.
Biondo S. Predictive factors of mortality in patients with colorectal perforation. Tech Coloproctol. 2004;8(1):37–40.
Teixeira PG. Complications and mortality of emergency colectomy. Am Surg. 2010;76(6):630–5.
Kruschewski M. Risk factors for postoperative complications in colorectal surgery. Int J Colorectal Dis. 2005;20(2):145–52.
Atamanalp SS. Sigmoid volvulus: Comprehensive review of 938 cases. Dis Colon Rectum. 2009;52(3):493–9.
Wexner SD. Peritoneal lavage in colorectal surgery: Indications and results. Dis Colon Rectum. 1994;37(1):45–52.
Goligher JC. Techniques in colorectal anastomosis. Br J Surg. 1986;73(1):21–4.
Nelson H. Complications and transfusions in emergency colectomy. Ann Surg. 2002;235(5):627–35.
Reissman P. Early oral feeding following colon surgery: Is it safe. Ann Surg. 1995;222(1):73–7. DOI: https://doi.org/10.1097/00000658-199507000-00012
Alves A. Outcome of emergency colorectal surgery: Risk factors and quality assessment. Br J Surg. 2005;92(2):204–9.
Horgan PG. Predictors of hospital stay after emergency colorectal surgery. Colorectal Dis. 2009;11(7):681–5.
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