Outcome of patients on renal replacement therapy after colorectal surgery.
OBJECTIVE
Patients on renal replacement therapy are reported to have a high complication rate after abdominal surgery, the result of uremia and immunosuppression. A review of this group of patients undergoing colorectal surgery was undertaken.


METHODS
Seventy-three separate colorectal operations were performed for 44 patients. Thirty-eight patients were on dialysis and 35 had a renal transplant. Data (coexisting disease, preoperative blood results, operative details, complications, and colorectal POSSUM score) were completed for each surgical event.


RESULTS
Forty-two elective and 31 emergency procedures were performed. Infective complications were common (overall 60 percent). There were two anastomotic leaks in the elective group, but five leaks from seven emergency anastomoses. Stomas were frequently raised. Ninety percent of patients who survived and had a defunctioning stoma underwent a successful reversal. The overall major complication rate after elective and emergency surgery was 19 and 81 percent, respectively, and mortality was 5 and 26 percent, respectively.


CONCLUSIONS
Renal patients have a high rate of complications after colorectal surgery, and emergency surgery has a significant risk of anastomotic leak. Primary anastomosis should be avoided in all patients undergoing emergency intestinal resections. Subsequent surgery to restore intestinal continuity is possible in 90 percent of patients with far fewer complications.
Krysa
J
J
Department of Colorectal Surgery, Guys and St. Thomas' Hospital, London, United Kingdom. jokrysa@aol.com
Patel
V
V
Taylor
J
J
Williams
A B
AB
Carapeti
E
E
George
M L
ML
D000328:Adult; D000368:Aged; D003107:Colorectal Surgery; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D017582:Renal Replacement Therapy; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome