Emergency Right Colon Resection

Miller, Frank B.

doi:10.1001/archsurg.1987.01400150093018

Cited by 11 publications

(6 citation statements)

References 15 publications

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“…Primary resection and anastomosis are the current treatment of choice for acute RSCO, and the great majority (94.8 %) of patients included in this review received this treatment. The overall mortality of around 10 % seems to be an improvement compared to 21 % seen in older studies [22] and might be due to advances in critical care, antibiotic use and CT-guided abscess drainage. Nevertheless, mortality after emergency resection is much higher than after elective resection, which confirms that emergency right hemicolectomy is a high-risk procedure [2,3,5].…”

Section: Discussionmentioning

confidence: 84%

Emergency resection versus bridge to surgery with stenting in patients with acute right-sided colonic obstruction: a systematic review focusing on mortality and morbidity rates

Amelung

Beaufort

Siersema

et al. 2015

Int J Colorectal Dis

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Primary resection for patients with acute RSCO seems to be associated with higher mortality and major morbidity rates than stent placement and elective resection. In addition, stent placement resulted in fewer anastomotic leakages and permanent ileostomies. However, as no high-level studies are available on the optimal treatment of RSCO and proximal stenting is considered technically challenging, future comparative studies are warranted for the development of an evidence-based clinical decision guideline.

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Section: Discussionmentioning

confidence: 84%

Emergency resection versus bridge to surgery with stenting in patients with acute right-sided colonic obstruction: a systematic review focusing on mortality and morbidity rates

Amelung

Beaufort

Siersema

et al. 2015

Int J Colorectal Dis

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“…A total of 83 postoperative complications developed in 48 patients (39.3%). The majority (41/48 ‫ס‬ 85.4%) of these patients developed complications related to infection including an intra-abdominal abscess (21), sepsis and multisystem organ failure (16), wound infections (5), and anastomotic leaks (6). The remainder of the complications were pulmonary, renal, and cardiac.…”

Section: Resultsmentioning

confidence: 99%

“…Our disappointingly high anastomotic leak rate of 6 per cent in the overall study population is similar to previously cited anastomotic leak rates for emergency right colectomy from 6.3 per cent to 10 per cent. [4][5][6] When looking at the trauma and nontrauma patients as subgroups, there appeared to be a difference in anastomotic leak rates in the trauma population as compared to the nontrauma population (11% vs 5%). Secondary to the small number of anastomotic leaks (6) in the series, this difference did not reach statistical significance (P ‫ס‬ 0.33).…”

Section: Discussionmentioning

confidence: 99%

Emergent Right Hemicolectomies

Wyrzykowski

Feliciano

George

et al. 2005

The American Surgeon™

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Emergent right hemicolectomies have historically been associated with surprisingly high morbidity and mortality rates. A retrospective review of emergent right hemicolectomies over a 7-year period was performed to assess current morbidity and mortality. Emergent right hemicolectomy was defined as a procedure performed for an acute abdomen with no formal preoperative cleansing of the colon. Demographic data, diagnostic evaluation, length of stay and outcomes were evaluated. Over the study period, 122 emergent right hemicolectomies were performed on both general surgery and trauma patients. The average patient was 52.9 ± 18.5 years old, and the majority of patients (66.4%) were male. The indications for the procedures performed were bowel perforation (51), hemorrhage (25), cancer (16), benign obstruction (14), phlegmon (8), ischemia (6), or other (2). Resection with primary anastomosis was performed in 98 patients, 16 had an end ileostomy, and 8 underwent damage control procedures in which gastrointestinal continuity was not reestablished at the time of the original operation. Postoperative complications developed in 48 patients (39.3%). The majority of the complications (83.3%) were related to infection including intra-abdominal abscess (21 patients), sepsis (16), and wound infection (5). Other complications included anastomotic leak (5), wound dehiscence (3), stoma-related (3) and postoperative bowel obstruction (2). The patients who developed complications did not differ from those who had an uneventful postoperative course in terms of age, indication for procedure, or presence of intra-abdominal abscess or gross contamination at the time of the original procedure. The overall mortality rate was 13 per cent. Patients who died were older than those who lived (63 ± 19 vs 52 ± 18; P = 0.03) and were significantly more likely to have evidence of shock on presentation ( P = 0.0013). Emergent right hemicolectomies continue to be associated with high morbidity and mortality rates. The most common complications are related to infection. Age and manifestations of shock at the time of admission are strong predictors of mortality.

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“…32,33 The method of anastomosis, be it handsewn or stapled, has not been shown to be significantly related to the development of an anastomotic leak or other complications in emergency right hemicolectomy. [33][34][35] This is supported in our series as there was no patient with primary anastomosis from either method that had any anastomotic complications.…”

Section: Discussionmentioning

confidence: 99%

“…This is not surprising, as diverting stoma has always been advocated in patients who are hemodynamically unstable or in those who are suspected to fare worse. 3,16 However, as 32,39,40 the authors opined that the optimal choice of surgical intervention should remain at the discretion of the primary surgeon with paramount considerations given to the general condition of the patient and degree of contamination.…”

Section: Discussionmentioning

confidence: 99%