[Typology of defunctioning colostomy and state of art in the treatment of bowel emergencies].
BACKGROUND
A trend toward avoidance of a defunctioning colostomy at emergency large-bowel surgery has been placed in recent years. The surgical management of patients with acute colonic disease has been evolving from multiple to single operations with a reduced use of colostomy.


RESULTS
One hundred four consecutive non-selected patients underwent surgery for left-sided large bowel emergencies between 1980-2003. Defunctioning colostomy was performed in 10 out of 58 resection-anastomosis procedures. Thirty-seven patients underwent Hartmann procedure, 9 received only diverting colostomy. Postoperative morbidity was 28.8%. Postoperative mortality 8.2%. Anastomotic leak occurred in 1 and 6 patients with and without defunctioning colostomy respectively. Four out of the 6 patients without colostomy needed reintervention, while patient with covering colostomy underwent conservative treatment. Six (10.5%) out 56 patients with colostomy experienced major stoma related complications and underwent reintervention.


CONCLUSIONS
Although there is general acceptance of one-stage surgery for right-sided colon emergencies, the surgical management of left-side large bowel obstruction and peritonitis remains controversal. Risk of anastomotic dehiscence associated with large-bowel anastomosis in unfavourable circumstance must be balanced against the high complications and low closure rates of a temporary colostomy.


CONCLUSIONS
Primary resection and anastomosis without diverting colostomy for left-sided acute obstruction and peritonitis may be performed in selected patients. Diffuse purulent and faecal peritonitis are contraindications to one-stage surgery being necessary a two- stage procedure with loop or end colostomy. Colostomy remain a valid surgical option when high risk of dehiscence is suspected.
Marin
Alfredo Wiel
AW
Università Cattolica del Sacro Cuore, Roma.
Di Giorgio
Andrea
A
Destito
C
C
Mercuri
M
M
Massari
Massimo
M
Ricciardi
V
V
Negro
F
F
De Fazio
S
S
Cozza
T
T
D003082:Colectomy; D003110:Colonic Neoplasms / Q000601:surgery; D003125:Colostomy / Q000379:methods*; D004630:Emergencies; D006801:Humans; D010166:Palliative Care; D018579:Patient Selection; D010538:Peritonitis / Q000601:surgery; D011183:Postoperative Complications; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation; D012307:Risk Factors