Small bowel anastomosis in emergency surgery

Area of Science:

• Gastroenterology
• Surgical Oncology
• Abdominal Surgery

Background:

• Emergency laparotomy carries significant morbidity and mortality risks.
• Current practices for anastomosis versus enterostomy in emergency small bowel resection lack evidence-based guidance, relying on surgeon preference.
• This study investigates the risks associated with small bowel resection and anastomosis in emergency surgical settings.

Purpose of the Study:

• To evaluate the outcomes of primary anastomosis versus enterostomy in emergency small bowel resections.
• To determine the anastomotic leak rate, mortality, and complication rates associated with different surgical approaches.
• To provide evidence-based insights into the decision-making process for bowel reconstruction in emergency surgery.

Main Methods:

• A retrospective study was conducted from 2016 to 2019 at a Danish university hospital.
• Included patients undergoing emergency laparotomies with small-bowel, ileocecal, right hemicolectomy, or extended right hemicolectomy.
• Data collected included demographics, operative details, reconstruction method (anastomosis or enterostomy), and postoperative complications.

Main Results:

• Out of 370 patients, 313 (84.6%) had an anastomosis and 57 (15.4%) had an enterostomy.
• The 30-day mortality rate was 12.7% overall, with 10.2% for anastomosis and 26.3% for enterostomy.
• The overall anastomotic leak rate was 1.6%, with specific rates of 3.0% for small-bowel to colon and 0.6% for small-bowel to small-bowel.

Conclusions:

• Primary anastomosis is the preferred method in over 80% of emergency small bowel resections.
• Performing a primary anastomosis in emergency settings is associated with a low rate of anastomotic leak.
• Anastomosis in emergency surgery demonstrates a lower mortality risk compared to enterostomy.