Small bowel anastomosis in emergency surgery.
Humans
Anastomosis, Surgical
/ methods
Retrospective Studies
Male
Female
Intestine, Small
/ surgery
Aged
Middle Aged
Emergencies
Denmark
/ epidemiology
Aged, 80 and over
Adult
Anastomotic Leak
/ epidemiology
Enterostomy
/ methods
Postoperative Complications
/ epidemiology
Laparotomy
/ methods
Emergency Treatment
critical care
gastrointestinal
infection
laparoscopy
outcomes
Journal
World journal of surgery
ISSN: 1432-2323
Titre abrégé: World J Surg
Pays: United States
ID NLM: 7704052
Informations de publication
Date de publication:
Feb 2024
Feb 2024
Historique:
received:
02
11
2023
accepted:
01
12
2023
medline:
30
4
2024
pubmed:
30
4
2024
entrez:
30
4
2024
Statut:
ppublish
Résumé
Emergency laparotomy is associated with a high morbidity and mortality rate. The decision on whether to perform an anastomosis or an enterostomy in emergency small bowel resection is guided by surgeon preference alone, and not evidence based. We examined the risks involved in small bowel resection and anastomosis in emergency surgery. A retrospective study from 2016 to 2019 in a university hospital in Denmark, including all emergency laparotomies, where small-bowel resections, ileocecal resections, right hemicolectomies and extended right hemicolectomies where performed. Demographics, operative data, anastomosis or enterostomy, as well as postoperative complications were recorded. Primary outcome was the rate of bowel anastomosis. Secondary outcomes were the anastomotic leak rate, mortality and complication rates. During the 3.5-year period, 370 patients underwent emergency bowel resection. Of these 313 (84.6%) received an anastomosis and 57 (15.4%) an enterostomy. The 30-day mortality rate was 12.7% (10.2% in patients with anastomosis and 26.3% in patients with enterostomy). The overall anastomotic leak rate was 1.6%, for small-bowel to colon 3.0% and for small-bowel to small-bowel 0.6%. A primary anastomosis is performed in more than eight out of 10 patients in emergency small bowel resections and is associated with a very low rate of anastomotic leak.
Sections du résumé
BACKGROUND
BACKGROUND
Emergency laparotomy is associated with a high morbidity and mortality rate. The decision on whether to perform an anastomosis or an enterostomy in emergency small bowel resection is guided by surgeon preference alone, and not evidence based. We examined the risks involved in small bowel resection and anastomosis in emergency surgery.
METHODS
METHODS
A retrospective study from 2016 to 2019 in a university hospital in Denmark, including all emergency laparotomies, where small-bowel resections, ileocecal resections, right hemicolectomies and extended right hemicolectomies where performed. Demographics, operative data, anastomosis or enterostomy, as well as postoperative complications were recorded. Primary outcome was the rate of bowel anastomosis. Secondary outcomes were the anastomotic leak rate, mortality and complication rates.
RESULTS
RESULTS
During the 3.5-year period, 370 patients underwent emergency bowel resection. Of these 313 (84.6%) received an anastomosis and 57 (15.4%) an enterostomy. The 30-day mortality rate was 12.7% (10.2% in patients with anastomosis and 26.3% in patients with enterostomy). The overall anastomotic leak rate was 1.6%, for small-bowel to colon 3.0% and for small-bowel to small-bowel 0.6%.
CONCLUSION
CONCLUSIONS
A primary anastomosis is performed in more than eight out of 10 patients in emergency small bowel resections and is associated with a very low rate of anastomotic leak.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
341-349Informations de copyright
© 2024 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).
Références
Clarke, Adrian, Henry Murdoch, Matthew J. Thomas, Tim M. Cook, and Carol J. Peden. 2011. “Mortality and Postoperative Care after Emergency Laparotomy.” European Journal of Anaesthesiology 28(1): 16–19. https://doi.org/10.1097/eja.0b013e32833f5389.
Al‐Temimi, Mohammed H., Matthew Griffee, Toby M. Enniss, Robert Preston, Daniel Vargo, Sean Overton, Edward Kimball, Richard Barton, and Raminder Nirula. 2012. “When Is Death Inevitable after Emergency Laparotomy? Analysis of the American College of Surgeons National Surgical Quality Improvement Program Database.” Journal of the American College of Surgeons 215(4): 503–511. https://doi.org/10.1016/j.jamcollsurg.2012.06.004.
van Goor, Harry. 2002. “Interventional Management of Abdominal Sepsis: When and How.” Langenbeck's Archives of Surgery 387(5–6): 191–200. https://doi.org/10.1007/s00423‐002‐0309‐7.
Wittmann, Dietmar H., Moshe Schein, and Robert E. Condon. 1996. “Management of Secondary Peritonitis.” Annals of Surgery 224(1): 10–18. https://doi.org/10.1097/00000658‐199607000‐00003.
Forgan, Timothy, and Robert Baigrie. 2018. “Acute Conditions of the Small Bowel and Appendix.” In Core Topics in General & Emergency Surgery, 193–215. Edinburgh: Elsevier.
Peden, Carol J., Geeta Aggarwal, Robert J. Aitken, Iain D. Anderson, Nicolai Bang Foss, Zara Cooper, Jugdeep K. Dhesi, et al. 2021. “Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS) Society Recommendations: Part 1‐Preoperative: Diagnosis, Rapid Assessment and Optimization.” World Journal of Surgery 45(5): 1272–1290. https://doi.org/10.1007/s00268‐021‐05994‐9.
Malik, T. A. M., M. J. Lee, and A. B. Harikrishnan. 2018. “The Incidence of Stoma Related Morbidity ‐ A Systematic Review of Randomised Controlled Trials.” Annals of the Royal College of Surgeons of England 100(7): 501–508. https://doi.org/10.1308/rcsann.2018.0126.
Skovsen, Anders Peter, Jakob Burcharth, Ismail Gögenur, and M.‐Britt Tolstrup. 2022. “Small Bowel Anastomosis in Peritonitis Compared to Enterostomy Formation: A Systematic Review.” European Journal of Trauma and Emergency Surgery 49(5): 2047–2055. (online ahead of print). https://doi.org/10.1007/s00068‐022‐02192‐7.
Coccolini, Federico, Derek Roberts, Luca Ansaloni, Rao Ivatury, Emiliano Gamberini, Yoram Kluger, Ernest E. Moore, et al. 2018. “The Open Abdomen in Trauma and Non‐Trauma Patients: WSES Guidelines.” World Journal of Surgery 13(1): 7. eCollection 2018. https://doi.org/10.1186/s13017‐018‐0167‐4.
Garner, Julia S. 1986. “CDC Guideline for Prevention of Surgical Wound Infections, 1985. Supersedes Guideline for Prevention of Surgical Wound Infections Published in 1982. (Originally Published in November 1985). Revised.” Infection Control 7(3): 193–200. https://doi.org/10.1017/s0195941700064080.
Dindo, Daniel, Nicolas Demartines, and P.‐Alain Clavien. 2004. “Classification of Surgical Complications: A New Proposal with Evaluation in a Cohort of 6336 Patients and Results of a Survey.” Annals of Surgery 240(2): 205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae.
Kirkpatrick, Andrew W., Keith A. Baxter, Richard K. Simons, Eva Germann, Charles E. Lucas, and Anna M. Ledgerwood. 2003. “Intra‐Abdominal Complications after Surgical Repair of Small Bowel Injuries: An International Review.” The Journal of Trauma 55(3): 399–406. https://doi.org/10.1097/01.ta.0000060248.87046.ee.
Sartelli, Massimo, Federico Coccolini, Yoram Kluger, Ervis Agastra, Fikri M. Abu‐Zidan, Ashraf El Sayed Abbas, Luca Ansaloni, et al. 2021. “WSES/GAIS/SIS‐E/WSIS/AAST Global Clinical Pathways for Patients with Intra‐Abdominal Infections.” World Journal of Emergency Surgery 16(1): 49. https://doi.org/10.1186/s13017‐021‐00387‐8.
Danish Colorectal Cancer Group. 2022. “National Yearly Report 2021.” https://dccg.dk/wp‐content/uploads/2022/10/DCCG‐Aarsrapport‐2021‐offentliggjort‐version‐20221003.pdf. Accessed Aug 21, 2023.