title: Avoiding diarrhea after subtotal colectomy with primary anastomosis in the treatment of colon cancer.
abstract: BACKGROUND
  Subtotal colectomy has been criticized as causing increased frequency of stool passage, thus adding to the patients' morbidity. We review our experience with subtotal colectomy and determine the factors affecting postoperative diarrhea.
  
  
  METHODS
  One hundred thirty-six patients with colon cancer were treated by primary subtotal colectomy. Of these, 30 percent underwent an emergency resection; 15 percent, semi-emergency resection; and 55 percent, elective subtotal colectomy. There were 29 complications and 3 deaths.
  
  
  RESULTS
  The incidence of complications was higher when the operation was carried out on an emergency or semi-emergency basis. In assessing the patients' increased postoperative stool frequency, there was no difference between the groups; but, the length of the remaining colon and the resected terminal ileum had a significant effect on postoperative diarrhea. If less than 10 cm of terminal ileum is resected and more than 10 cm of colon is left above the peritoneal reflection, there is a marked decrease in the incidence of diarrhea after subtotal colectomy.
  
  
  CONCLUSIONS
  Subtotal colectomy is an acceptable treatment for left colonic carcinoma, electively as well as in emergency situations. Postoperative diarrhea can be minimized by attention to the length of small bowel and sigmoid that are resected.
authors.affiliation: Department of General and Oncological Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: M Z
authors.initials: MZ
authors.lastname: Papa
authors.forename: T
authors.initials: T
authors.lastname: Karni
authors.forename: M
authors.initials: M
authors.lastname: Koller
authors.forename: E
authors.initials: E
authors.lastname: Klein
authors.forename: D
authors.initials: D
authors.lastname: Scott
authors.forename: D
authors.initials: D
authors.lastname: Bersuk
authors.forename: M
authors.initials: M
authors.lastname: Sareli
authors.forename: G
authors.initials: G
authors.lastname: Ben Ari
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods; D003110:Colonic Neoplasms / Q000601:surgery*; D003967:Diarrhea / Q000209:etiology / Q000517:prevention & control*; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies