Abstract
Introduction
Emergency right hemicolectomy has been associated with dismal outcome. But, data in Asians is lacking as pathologies that require emergency right hemicolectomy may differ from that in the Western population. The aims of our study were to review our institution’s experience with emergency right hemicolectomies and to identify factors that could predict the per-operative outcome.
Methods
A retrospective review of all patients who underwent emergency right hemicolectomy from August 2003 to April 2008 was performed. Emergency right hemicolectomy was defined as a right colectomy, comprising of an ileo-colic resection, in the emergency setting without the benefit of preoperative bowel preparation.
All the complications were graded according to the classification proposed by Clavien and group.
Results
A total of 207 patients, median age 62 years (range, 19–94 years), underwent emergency right hemicolectomy during the study period. Neoplasia and complicated diverticular disease were the most common pathologies in 46.4% and 21.7%, respectively. Intestinal obstruction (44.4%) and perforation (26.6%) were the two main indications for surgical intervention in our series. Twenty (9.7%) patients died, and another 39 patients (18.8%) had severe complications. Eight (3.9%) patients had anastomotic dehiscence, while burst abdomen was seen in ten (4.8%) patients. The two independent factors associated with worse outcome were high ASA score and stoma creation. Factors such as age and site of perforation were not related.
Conclusion
Emergency right hemicolectomy is associated with a significant morbidity and mortality rate. Patients with higher ASA score and who had stoma created fared worse.
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References
Buchs NC, Gervaz P, Secic M, Bucher P, Mugnier-Konrad B, Morel P (2008) Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study. Int J Colorectal Dis 23(3):265–270
Veyrie N, Ata T, Muscari F, Couchard AC, Msika S, Hay JM, Fingerhut A, Dziri C (2007) Anastomotic leakage after elective right versus left colectomy for cancer: prevalence and independent risk factors. J Am Coll Surg 205(6):785–793
Wyrzykowski AD, Feliciano DV, George TA, Tremblay LN, Rozycki GS, Murphy TW, Dente CJ (2005) Emergent right hemicolectomies. Am Surg 71(8):653–656
Miller FB, Nikolov NR, Garrison RN (1987) Emergency right colon resection. Arch Surg 122(3):339–343
Lee YS (1986) Diverticular disease of the large bowel in Singapore: an autopsy survey. Dis Colon Rectum 29(5):330–335
Sugihara K, Muto T, Morioka Y, Asano A, Yamamoto T (1984) Diverticular disease of the colon in Japan. A review of 615 cases. Dis Colon Rectum 27(8):531–537
Wu X, Chen VW, Martin J, Roffers S, Groves FD, Correa CN, Hamilton-Byrd E, Jemal A (2004) Subsite-specific colorectal cancer incidence rates and stage distributions among Asians and Pacific Islanders in the United States, 1995 to 1999. Cancer Epidemiol Biomarkers Prev 13(7):1215–1222
Clavien PA, Sanabria JR, Mentha G, Borst F, Buhler L, Roche B, Cywes R, Tibshirani R, Rohner A, Strasberg SM (1992) Recent results of elective open cholecystectomy in a North American and a European center. Comparison of complications and risk factors. Ann Surg 216(6):618–626
Clavien PA, Camargo CA Jr, Croxford R, Langer B, Levy GA, Greig PD (1994) Definition and classification of negative outcomes in solid organ transplantation. Application in liver transplantation. Ann Surg 220(2):109–120
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213
Sarkar R, Bennion RS, Schmit PJ, Thompson JE (1997) Emergent ileocecectomy for infection and inflammation. Am Surg 63(10):874–877
Biondo S, Parés D, Kreisler E, Ragué JM, Fraccalvieri D, Ruiz AG, Jaurrieta E (2005) Anastomotic dehiscence after resection and primary anastomosis in left-sided colonic emergencies. Dis Colon Rectum 48(12):2272–2280
Sjo OH, Larsen S, Lunde OC, Nesbakken A (2009) Short term outcome after emergency and elective surgery for colon cancer. Colorectal Dis 11(7):733–739
Biondo S, Ramos E, Deiros M, Ragué JM, De Oca J, Moreno P, Farran L, Jaurrieta E (2000) Prognostic factors for mortality in left colonic peritonitis: a new scoring system. J Am Coll Surg 191(6):635–642
Chandra V, Nelson H, Larson DR, Harrington JR (2004) Impact of primary resection on the outcome of patients with perforated diverticulitis. Arch Surg 139(11):1221–1224
Ng SS, Lee JF, Yiu RY, Li JC, Leung WW, Leung KL (2008) Emergency laparoscopic-assisted versus open right hemicolectomy for obstructing right-sided colonic carcinoma: a comparative study of short-term clinical outcomes. World J Surg 32(3):454–458
Li JC, Ng SS, Lee JF, Yiu RY, Hon SS, Leung WW, Leung KL (2009) Emergency laparoscopic-assisted versus open right hemicolectomy for complicated cecal diverticulitis: a comparative study. J Laparoendosc Adv Surg Tech A 19(4):479–483
Stulberg JJ, Champagne BJ, Fan Z, Horan M, Obias V, Marderstein E, Reynolds H, Delaney CP (2009) Emergency laparoscopic colectomy: does it measure up to open? Am J Surg 197(3):296–301
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Tan, KK., Liu, J.Z., Yeow, Y. et al. Is emergency right hemicolectomy still associated with significant morbidity and mortality rates? An institution’s experience of 207 cases over 6 years. Int J Colorectal Dis 26, 1157–1161 (2011). https://doi.org/10.1007/s00384-011-1203-y
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DOI: https://doi.org/10.1007/s00384-011-1203-y