Immediate resection in emergency large bowel surgery: a 7 year audit

Area of Science:

• Gastroenterology
• Surgical Gastroenterology
• Colorectal Surgery

Background:

• Large bowel emergencies represent a significant cause of emergency hospital admissions.
• Colonic obstruction and peritonitis are the most frequent indications for surgical intervention.

Purpose of the Study:

• To evaluate the outcomes of urgent surgical management for large bowel emergencies.
• To assess the safety and efficacy of primary resection and immediate anastomosis in these patients.

Main Methods:

• Retrospective analysis of 153 consecutive emergency admissions for large bowel disease over a 7-year period.
• Evaluation of surgical interventions, including primary resection and immediate anastomosis.
• Analysis of postoperative outcomes such as mortality, sepsis rates, and hospital stay.

Main Results:

• 68% of patients underwent urgent operations, with 79% having primary resection.
• Primary resection had a 12.2% mortality rate and low intraperitoneal (2.4%) and wound (7.3%) sepsis rates.
• Immediate anastomosis in 56% of operated patients showed an 8.7% mortality rate and 2.2% anastomotic leak rate.
• Mortality is linked to patient age and advanced malignancy.

Conclusions:

• Urgent surgical intervention, including primary resection, is feasible in over 80% of patients with large bowel emergencies.
• Immediate anastomosis following proximal colonic resection is safe.
• Intra-operative colonic irrigation facilitates primary anastomosis in selected distal colon resections, offering potentially lower morbidity and cost-effective treatment.