title: Emergency right colectomy: which strategy when primary anastomosis is not feasible?
abstract: BACKGROUND
  Primary anastomosis is considered the standard strategy after right emergency colectomy. The present study aimed to evaluate alternative treatment strategies when primary anastomosis is not possible to prevent definitive ostomy.
  
  
  METHODS
  This retrospective study included all consecutive patients who underwent right emergency colectomy between July 2006 and June 2013. Demographics, surgical data, and postoperative outcomes were entered in an anonymized database. Comparative analysis was performed between patients with primary anastomosis (PA group) and those where alternative strategies were employed (no-PA group). Outcomes were 30 days complications rate and rate of bowel continuity restoration.
  
  
  RESULTS
  One hundred forty-eight patients (57 % male) with a median age of 65 years (15-96) were included. One hundred and sixteen patients underwent PA (78 %) and 32 were in the no-PA group (22 %). No-PA group patients had more comorbidities (Carlson comorbidity index >3: 98 % vs. 54, p < 0.001). Major complications rate (Dindo-Clavien III to IV) was 24 % in PA group, 88 % in no-PA group (p < 0.001). The 30-day mortality rate was 6 % (n = 7) in PA group versus 25 % (n = 8) in no-PA group (p = 0.004). Fourteen patients in the no-PA group had a split stoma and 18 had a two-staged procedure. Five patients had continuity restoration after initial split stoma (36 %) compared to 10 after a two-staged procedure (55 %; p = 0.265). Anastomotic leak occurred in 10 patients of the PA group (9 %) versus 0 in the no-PA group, where 15 out of 32 patients (47 %) had continuity restoration.
  
  
  CONCLUSIONS
  Eighty percent of patients requiring emergency right colectomy were anastomosed primarily. For the remaining a two-staged procedure might facilitate bowel continuity restoration in the long-term.
authors.affiliation: Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, 1011 Switzerland.
authors.forename: Hugo
authors.initials: H
authors.lastname: Teixeira Farinha
authors.affiliation: Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, 1011 Switzerland.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Melloul
authors.affiliation: Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, 1011 Switzerland.
authors.forename: Dieter
authors.initials: D
authors.lastname: Hahnloser
authors.affiliation: Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, 1011 Switzerland.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demartines
authors.affiliation: Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, 1011 Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Hübner