title: Resection and primary anastomosis without diverting ileostomy for left colon emergencies: is it a safe procedure?
abstract: BACKGROUND
  Large-bowel obstruction and perforation are still frequently occurring entities for the acute care surgeon. In these cases, Hartmann's procedure is the most commonly used surgical technique. However, recent papers demonstrate that colon resection and primary anastomosis (RPA) in the emergency setting is a safe and feasible procedure. We present our series of left colon resection and primary anastomosis procedures from Torrevieja Hospital (Alicante, Spain), performed without bowel irrigation or a diverting ileostomy.
  
  
  METHODS
  Thirty-two RPA procedures were performed in emergency settings for perforation or obstruction, or both, during an 18-month period. The following data were prospectively collected: age, gender, nationality, diagnoses, ASA score, body mass index (BMI), POSSUM score (Physiological and Operative Severity Score for the enumeration of Mortality and morbidity), and the score according to the Hinchey classification. Furthermore, duration of the operation, length of postoperative hospital stay, and mortality and morbidity data were recorded.
  
  
  RESULTS
  Sixteen of these patients were diagnosed with acute diverticulitis, 14 patients with neoplasm (of which 9 cases had obstruction, 2 cases had perforation, and 3 cases had both), and foreign body perforation in the remaining 2 cases. The mean hospital stay was 7.8 (range, 4-10) days. The physiological POSSUM score was 24.4 (range, 15-39), and the surgical POSSUM score was 19.8 (range, 16-24). None of the patients died (0% mortality). Seven patients developed some kind of complication (21.9%), all of which were managed conservatively.
  
  
  CONCLUSIONS
  The results of this study suggest that RPA for left colon obstruction and perforation in emergency settings can be safely performed in certain surgical conditions.
authors.affiliation: General and Digestive Tract Department, Marina Baja Medical Center, Alcalde En Jaume Botella Mayor 7, 03570, Villajoyosa, Alicante, Spain.
authors.forename: Montiel
authors.initials: M
authors.lastname: Jiménez Fuertes
authors.affiliation: General and Digestive Tract Department, Marina Baja Medical Center, Alcalde En Jaume Botella Mayor 7, 03570, Villajoyosa, Alicante, Spain . davidcir@hotmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Costa Navarro
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D003082:Colectomy; D003106:Colon / Q000601:surgery*; D003108:Colonic Diseases / Q000150:complications / Q000601:surgery*; D004630:Emergencies; D005260:Female; D006801:Humans; D007081:Ileostomy; D007415:Intestinal Obstruction / Q000150:complications / Q000601:surgery*; D007416:Intestinal Perforation / Q000150:complications / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome