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Resection enterostomy versus Hartmann's procedure for emergency colonic resections
M Grott1, K Horisberger2, C Weiß3
1Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany.
International Journal of Colorectal Disease
|April 9, 2017
Summary
Restoring bowel continuity after emergency colon resection is possible for most patients. Neither Hartmann's procedure nor resection enterostomy showed significant differences in morbidity or restoration rates, though Hartmann's took longer.
Area of Science:
- Colorectal Surgery
- Surgical Outcomes
- Emergency Medicine
Background:
- Emergency colon resections may necessitate alternatives to primary anastomosis due to high risk.
- Resection enterostomy and Hartmann's procedure (end stoma with distal closure) are viable options.
Purpose of the Study:
- To compare surgical outcomes, focusing on the rate of intestinal continuity restoration, between resection enterostomy and Hartmann's procedure for emergency colon resections.
Main Methods:
- Retrospective review of patients undergoing emergency colorectal resections between 2009-2014.
- Analysis of therapeutic approach, primary operation morbidity, and reversal surgery outcomes.
Main Results:
- Higher revisional surgery rates in the resection enterostomy group post-operation.
- No significant differences in morbidity, mortality, or bowel continuity restoration rates between the two groups.
- Bowel continuity restored in 63% of surviving patients; Hartmann's procedure involved longer surgery times and protective ileostomies in some cases.
Conclusions:
- Bowel continuity is achievable in most patients following emergency colon resection.
- Current evidence is insufficient to definitively prefer Hartmann's procedure over resection enterostomy, or vice versa, when primary anastomosis is contraindicated.