Elective right hemicolectomy: a twenty-year retrospective analysis of a single general surgeon's practice

Changes in working practices implemented over the last decade particularly with respect to subspecialisation have changed the working practices of the traditional general surgeon. The majority of non-colorectal specialists who wish to continue abdominal surgery have been limited to pursue right sided colorectal pathology only. The aim of this study was to assess the outcomes of colorectal procedures performed by one non-colorectal specialist general surgeon who commenced consultant practice in 1991 and compare these outcomes against the outcomes recorded in the literature for low and high volume caseload surgeons.

The patient records of 131 patients who underwent right hemicolectomy by a single surgeon between March 1991 and December 2010 were retrieved and retrospectively analysed. All patients underwent midline laparotomy with two-layer handsewn end-end or end-side ileocolonic anastomoses. Complications of interest were postoperative deaths and clinically relevant anastomotic leaks as well as clinically diagnosed medical complications.

The mean age of patients was 61.5 years (range 17-83). A total of 92 patients were operated upon for colorectal malignancy and 39 patients for crohn's disease. No anastomotic leaks occurred. There was only a single inpatient death secondary to acute myocardial infarction.

Our small study of a single surgeon's career long practice for elective right hemicolectomies demonstrates that high standards in terms of anastomotic leak rates and operative mortality can be achieved in clinical practice by the non-specialist General Surgeon. However, prospective data collection would be required to apply this to the broader non-colorectal specialist community.