title: Efficacy of loop colostomy construction for acute left-sided colonic obstructions: a cohort analysis.
abstract: OBJECTIVE
  Acute primary resection as treatment for left-sided colonic obstruction (LSCO) is notorious for its high morbidity and mortality rates. Both stenting and loop colostomy construction can serve as a bridge to surgery, hereby avoiding the high morbidity and mortality rates associated with emergency resections. This study aims to investigate the safety of a loop colostomy in patients presenting with acute LSCO.
  
  
  METHODS
  Retrospective analysis of all patients that received a loop colostomy for LSCO between 2003 and 2015 was performed. Primary outcomes were mortality, major morbidity (Clavien-Dindo grades III-IV) and minor morbidity (Clavien-Dindo grades I-II).
  
  
  RESULTS
  One hundred forty-six patients presenting with acute LSCO received a diverting colostomy. After colostomy construction, mortality occurred in four patients (2.7%) and major complications were reported in 20 patients (13.7%). In 61 patients, the diverting colostomy served as a palliative measure, because of metastatic disease or unfitness for major surgery. The remaining 85 patients all underwent delayed resection, resulting in an overall mortality, major morbidity and minor morbidity of 6.9% (n = 6), 14.0% (n = 12) and 26.7% (n = 23), respectively.
  
  
  CONCLUSIONS
  Diverting colostomy construction is a minimally invasive and safe treatment option for LSCO. It can serve as a definite palliative measure, as well as a bridge to elective surgery. A diverting colostomy as a bridge to surgery might even be a valid alternative for emergency resections, since mortality and morbidity rates following colostomy construction and delayed resection appear lower than reported outcomes following primary resection.
authors.affiliation: Department of Surgery, Meander Medical Centre, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands.
authors.forename: Femke J
authors.initials: FJ
authors.lastname: Amelung
authors.affiliation: Department of Surgery, Meander Medical Centre, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands.
authors.forename: Charlotte L J
authors.initials: CL
authors.lastname: Mulder
authors.affiliation: Department of Surgery, Meander Medical Centre, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands.
authors.forename: Ivo A M J
authors.initials: IA
authors.lastname: Broeders
authors.affiliation: Department of Surgery, Meander Medical Centre, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands.
authors.forename: Esther C J
authors.initials: EC
authors.lastname: Consten
authors.affiliation: Department of Surgery, Meander Medical Centre, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands. wa.draaisma@meandermc.nl.
authors.forename: Werner A
authors.initials: WA
authors.lastname: Draaisma
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003125:Colostomy; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D054047:Surgical Stomas; D016896:Treatment Outcome
keywords: Bridge to surgery; Colon cancer; Colostomy; Left-sided colonic obstruction; Primary resection