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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.
METHODS AND 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.
DISCUSSION: 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.
CONCLUSION: 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.