EMERGENCY SURGERY FOR NEOPLASTIC LEFT COLON OBSTRUCTION: RESECTION AND PRIMARY ANASTOMOSYS (RPA) VERSUS HARTMANN RESECTION (HR)

Abstract

This retrospective study compares: hospitalization time, morbidity and mortality (patients operated for neoplastic occlusion of the left colon in emergency, without perforation), considering hanestesiologic risk and surgical technique (RPA versus RH).

Materials and Methods: From April 1999 to February 2003 the Emergency Surgery of AORN of Caserta has operated, in urgency, 60 neoplastic patients with left colon occlusion realizing: 46 (76,5%) RPA [36 ASA < or = III, low hanestesiologic risk (LAR), 10 ASA = or > IV, high hanestesiologic risk (HAR)], 12 (20%) RH (2 LAR and 10 HAR) 2 (3,5%) palliative colostomics .

Results: 36 LAR patients with RPA had 5% of specific complications and 5% of medical complications. 2 LAR patients with RH: no complication. 10 HAR patient with RPA brought 10% of specific complications and 10% of medical complications. 10 HAR patients with RH had 20% of specific complications and 10% of general complications. The middle hospitalization of LAR patients with RPA was 11 days versus 9 days of RH pz. (equal hanestesiologic risk ). The HAR pz., treated with RPA, had as middle hospitalization 15 ggs in comparison to the 9 ggs of the HRA pz. treated with RH.

Mortality: 1/36 for LAR pz. with RPA (3%), and 0/0 for LAR pz. with RH; 1/10 for HAR pz. with RPA (10%) and 1/10 for HAR pz. with RH (10%).

Conclusions: resection and primary anastomosis, (correct indications and expert surgeon), give prevalence of complications and mortality similar to the repeated surgical procedure, a better life quality, but an higher number of postoperating hospitalisation days.