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Safety of primary anastomosis following emergency left sided colorectal resection : an international, multi-centre prospective audit

Sánchez-Guillén, Luis and Bhangu, Aneel (2018) In Colorectal Disease 20(Suppl 6). p.47-57
Abstract

INTRODUCTION: Some evidence suggests that primary anastomosis following left sided colorectal resection in the emergency setting may be safe in selected patients, and confer favourable outcomes to permanent enterostomy. The aim of this study was to compare the major postoperative complication rate in patients undergoing end stoma vs primary anastomosis following emergency left sided colorectal resection.

METHODS: A pre-planned analysis of the European Society of Coloproctology 2017 audit. Adult patients (> 16 years) who underwent emergency (unplanned, within 24 h of hospital admission) left sided colonic or rectal resection were included. The primary endpoint was the 30-day major complication rate (Clavien-Dindo grade 3 to... (More)

INTRODUCTION: Some evidence suggests that primary anastomosis following left sided colorectal resection in the emergency setting may be safe in selected patients, and confer favourable outcomes to permanent enterostomy. The aim of this study was to compare the major postoperative complication rate in patients undergoing end stoma vs primary anastomosis following emergency left sided colorectal resection.

METHODS: A pre-planned analysis of the European Society of Coloproctology 2017 audit. Adult patients (> 16 years) who underwent emergency (unplanned, within 24 h of hospital admission) left sided colonic or rectal resection were included. The primary endpoint was the 30-day major complication rate (Clavien-Dindo grade 3 to 5).

RESULTS: From 591 patients, 455 (77%) received an end stoma, 103 a primary anastomosis (17%) and 33 primary anastomosis with defunctioning stoma (6%). In multivariable models, anastomosis was associated with a similar major complication rate to end stoma (adjusted odds ratio for end stoma 1.52, 95%CI 0.83-2.79, P = 0.173). Although a defunctioning stoma was not associated with reduced anastomotic leak (12% defunctioned [4/33] vs 13% not defunctioned [13/97], adjusted odds ratio 2.19, 95%CI 0.43-11.02, P = 0.343), it was associated with less severe complications (75% [3/4] with defunctioning stoma, 86.7% anastomosis only [13/15]), a lower mortality rate (0% [0/4] vs 20% [3/15]), and fewer reoperations (50% [2/4] vs 73% [11/15]) when a leak did occur.

CONCLUSIONS: Primary anastomosis in selected patients appears safe after left sided emergency colorectal resection. A defunctioning stoma might mitigate against risk of subsequent complications.

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author
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contributor
LU ; LU and LU
author collaboration
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Adolescent, Adult, Aged, Anastomosis, Surgical/methods, Colectomy/adverse effects, Emergency Treatment/adverse effects, Europe, Female, Humans, Male, Medical Audit, Middle Aged, Multivariate Analysis, Postoperative Complications/etiology, Proctectomy/adverse effects, Prospective Studies, Surgical Stomas/statistics & numerical data, Treatment Outcome, Young Adult
in
Colorectal Disease
volume
20
issue
Suppl 6
pages
47 - 57
publisher
Wiley-Blackwell
external identifiers
  • scopus:85053853532
  • pmid:30255647
ISSN
1462-8910
DOI
10.1111/codi.14373
language
English
LU publication?
no
additional info
Colorectal Disease © 2018 The Association of Coloproctology of Great Britain and Ireland.
id
69d33eb2-3acd-4eba-b6d2-9d386930f5e6
date added to LUP
2021-12-29 12:00:09
date last changed
2024-03-23 17:11:06
@article{69d33eb2-3acd-4eba-b6d2-9d386930f5e6,
  abstract     = {{<p>INTRODUCTION: Some evidence suggests that primary anastomosis following left sided colorectal resection in the emergency setting may be safe in selected patients, and confer favourable outcomes to permanent enterostomy. The aim of this study was to compare the major postoperative complication rate in patients undergoing end stoma vs primary anastomosis following emergency left sided colorectal resection.</p><p>METHODS: A pre-planned analysis of the European Society of Coloproctology 2017 audit. Adult patients (&gt; 16 years) who underwent emergency (unplanned, within 24 h of hospital admission) left sided colonic or rectal resection were included. The primary endpoint was the 30-day major complication rate (Clavien-Dindo grade 3 to 5).</p><p>RESULTS: From 591 patients, 455 (77%) received an end stoma, 103 a primary anastomosis (17%) and 33 primary anastomosis with defunctioning stoma (6%). In multivariable models, anastomosis was associated with a similar major complication rate to end stoma (adjusted odds ratio for end stoma 1.52, 95%CI 0.83-2.79, P = 0.173). Although a defunctioning stoma was not associated with reduced anastomotic leak (12% defunctioned [4/33] vs 13% not defunctioned [13/97], adjusted odds ratio 2.19, 95%CI 0.43-11.02, P = 0.343), it was associated with less severe complications (75% [3/4] with defunctioning stoma, 86.7% anastomosis only [13/15]), a lower mortality rate (0% [0/4] vs 20% [3/15]), and fewer reoperations (50% [2/4] vs 73% [11/15]) when a leak did occur.</p><p>CONCLUSIONS: Primary anastomosis in selected patients appears safe after left sided emergency colorectal resection. A defunctioning stoma might mitigate against risk of subsequent complications.</p>}},
  author       = {{Sánchez-Guillén, Luis and Bhangu, Aneel}},
  issn         = {{1462-8910}},
  keywords     = {{Adolescent; Adult; Aged; Anastomosis, Surgical/methods; Colectomy/adverse effects; Emergency Treatment/adverse effects; Europe; Female; Humans; Male; Medical Audit; Middle Aged; Multivariate Analysis; Postoperative Complications/etiology; Proctectomy/adverse effects; Prospective Studies; Surgical Stomas/statistics & numerical data; Treatment Outcome; Young Adult}},
  language     = {{eng}},
  number       = {{Suppl 6}},
  pages        = {{47--57}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Colorectal Disease}},
  title        = {{Safety of primary anastomosis following emergency left sided colorectal resection : an international, multi-centre prospective audit}},
  url          = {{http://dx.doi.org/10.1111/codi.14373}},
  doi          = {{10.1111/codi.14373}},
  volume       = {{20}},
  year         = {{2018}},
}