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Safety of primary anastomosis following emergency left sided colorectal resection: an international, multi-centre prospective audit
Safety of primary anastomosis following emergency left sided colorectal resection: an international, multi-centre prospective audit
- Source :
- Christensen, P & 2017 European Society of Coloproctology (ESCP) collaborating group 2018, ' Safety of primary anastomosis following emergency left sided colorectal resection: an international, multi-centre prospective audit ', Colorectal Disease, vol. 20 Suppl 6, pp. 47-57 . https://doi.org/10.1111/codi.14373, El-Hussuna, A, Ceccotti, A A, Madsbøll, T K, Ovesen, A U, Straarup, D & 2017 European Society of Coloproctology (ESCP) collaborating group 2018, ' Safety of primary anastomosis following emergency left sided colorectal resection : an international, multi-centre prospective audit ', Colorectal Disease, vol. 20, no. Suppl. 6, pp. 47-57 . https://doi.org/10.1111/codi.14373
- Publication Year :
- 2018
- Publisher :
- Blackwell Publishing Ltd, 2018.
-
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 (>16years) who underwent emergency (unplanned, within 24h 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.
- Subjects :
- Male
Medical audit
Treatment outcome
anastomotic leak
030230 surgery
0302 clinical medicine
Postoperative Complications
Prospective Studies
Multi centre
emergency surgery
Prospective cohort study
Colectomy
Medical Audit
Proctectomy
Proctectomy/adverse effects
Prospective audit
Primary anastomosis
Anastomosis, Surgical
Gastroenterology
Middle Aged
surgical complications
Europe
Treatment Outcome
colon cancer
gastrointestinal surgery
rectal cancer
Surgery
surgical outcomes
030220 oncology & carcinogenesis
Postoperative Complications/etiology
Female
Colectomy/adverse effects
Emergency Treatment/adverse effects
Adult
medicine.medical_specialty
Adolescent
surgical outcome
Left sided
NO
03 medical and health sciences
Young Adult
surgical complication
medicine
Humans
Emergency Treatment
Colorectal resection
Aged
ta3126
Anastomosis, Surgical/methods
business.industry
General surgery
Surgical Stomas
Surgical Stomas/statistics & numerical data
Settore MED/18 - Chirurgia Generale
Multivariate Analysis
business
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- Christensen, P & 2017 European Society of Coloproctology (ESCP) collaborating group 2018, ' Safety of primary anastomosis following emergency left sided colorectal resection: an international, multi-centre prospective audit ', Colorectal Disease, vol. 20 Suppl 6, pp. 47-57 . https://doi.org/10.1111/codi.14373, El-Hussuna, A, Ceccotti, A A, Madsbøll, T K, Ovesen, A U, Straarup, D & 2017 European Society of Coloproctology (ESCP) collaborating group 2018, ' Safety of primary anastomosis following emergency left sided colorectal resection : an international, multi-centre prospective audit ', Colorectal Disease, vol. 20, no. Suppl. 6, pp. 47-57 . https://doi.org/10.1111/codi.14373
- Accession number :
- edsair.doi.dedup.....72b97a38f34f567c979bddaacc9c29ed
- Full Text :
- https://doi.org/10.1111/(ISSN)1463-1318