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Management of left-sided colonic obstruction by subtotal colectomy and ileocolic anastomosis
P H Reemst1, H C Kuijpers, T Wobbes
1Department of Surgery, Diakonessenhuis Eindhoven, Recklinghausen, Germany.
Objective:
To assess complications and functional results of emergency subtotal colectomy with ileocolic anastomosis for acute left-sided colonic obstruction.
Design:
Retrospective study.
Setting:
University hospital, Netherlands.
Subjects:
37 patients with acute left-sided colonic obstruction.
Interventions:
Emergency subtotal colectomy with immediate anastomosis (n = 20), Hartmann's procedure (n = 13) or double-loop transverse colostomy (n = 4).
Main Outcome Measures:
Mortality, morbidity, duration of hospital stay, frequency of defecation, and continence.
Results:
Morbidity after subtotal colectomy was 10% (n = 2) and mortality 0. There was one anastomotic dehiscence that required a temporary ileostomy. Mean hospital stay was 15 days (range 10-31). All had adequate continence. After 6 weeks mean frequency of defecation was 3/24 hrs (range 2-6). 9 patients died within 2 years of metastatic disease.
Conclusions:
Subtotal colectomy with ileocolic anastomosis is a suitable procedure for treating left-sided colonic obstruction provided that pelvic floor function is adequate and a skilled surgeon is available.