Nonelective excisional colorectal surgery in English National Health Service Trusts: a study of outcomes from Hospital Episode Statistics Data between 1996 and 2007

BACKGROUND

Nonelective colorectal surgery is associated with substantial patient morbidity and mortality. This study sought to describe the practice of emergency colorectal surgery in the United Kingdom during an 11-year period using the Hospital Episode Statistics (HES) database.

STUDY DESIGN

All nonelective admissions in patients undergoing 1 of 8 colorectal resectional procedures between 1996 and 2007 were included. Time trends, univariate, and multivariate mortality and length of stay outcomes were analyzed.

RESULTS

A total of 102,236 major urgent/emergency procedures were performed in English National Health Service Trusts between April 1996 and March 2007. Thirty-day in-hospital postoperative mortality rates in patients with colorectal cancer and diverticular disease were 13.3% and 15.4%, respectively. The corresponding 1-year postoperative mortality was 34.7% and 22.6%. On multivariate analysis, benign diagnosis, advanced age, high comorbidity score, social deprivation, and specific procedure types were independent predictors of early and 1-year postoperative mortality (p < 0.001). Independent risk factors for extended hospital stay were advanced age, social deprivation, distal (compared with proximal) bowel resection, and a diagnosis of ulcerative colitis (p < 0.001).

CONCLUSIONS

HES data suggest that in everyday practice, postoperative mortality among patients undergoing nonelective admission followed by colorectal resection is high. Additional investigation is required to assess the reliability of HES data for monitoring institutional variation in this context.

[Case of massive bleeding from diverticulosis of the colon in high risk mechanically ventilated patient]

This 81 years old man with chronic obstructive pulmonary disease (COPD), chronic sepsis, chronic renal failure dependent on mechanical ventilation presented in the course of treatment with massive lower gastrointestinal bleeding (LGIB). Selective angiography of inferior mesenteric artery was performed 18 hours after first bleeding and localized source of bleeding at the distal colon as a contrast in the lumen of the gut. Direct intraarterial injection of 3.4 micrograms Vasopressin was carried out in inferior mesentery artery for preparation of surgery. During surgery the colonoscopy was done and despite of the high operative risk total colectomy with ileostomy was performed. This case confirms that there are not alternatives of colectomy in continuing LGIB from colonic diverticula even in the high risk patients.

Smoking increases the incidence of complicated diverticular disease of the sigmoid colon

BACKGROUND AND AIMS

The aim of this study was to establish whether smoking is associated with complicated diverticular disease and adverse outcomes of operative treatment of diverticular disease. Smoking has been associated with increased rate of perforations in acute appendicitis as well as failure of colonic anastomosis in patients resected for colonic tumours. It has also been suggested that smoking is a risk factor for complicated diverticular disease of the colon.

MATERIAL AND METHODS

Retrospective investigation of records of 261 patients electively operated for diverticular disease in Helsinki University Central Hospital during a period of five years.

RESULTS

The smokers underwent sigmoidectomy at a younger age than the non-smokers (p = 0.001) and they had an increased rate of perforations (p = 0.040) and postoperative recurrent diverticulitis episodes (p = 0.019).

CONCLUSIONS

We conclude that smoking increases the likelihood of complications in diverticulosis coli. The development of complicated disease also seems to proceed more rapidly in smokers.Key words: Sigmoid resection; laparoscopy; laparoscopic sigmoidectomy; smoking and diverticular disease; complicated diverticular disease; diverticulitis.

[A man with chronic abdominal pain and obstipation]

A 66-year old man presents with chronic pain in the abdomen and obstipation. Explorative laparotomy revealed that his symptoms were caused by a giant diverticle from the colon sigmoideum.

[Giant colonic diverticulum. Report of a case and review of the literature]

We report about a 67 year-old male patient with a giant colonic diverticulum and multiple comorbid conditions. The unusual clinical presentation and high surgical risk in this case required challenging therapeutic decisions that eventually lead to a left colon resection and complementary surgical procedures, despite the patient had been considered non-surgical candidate by two surgical teams before. A literature review from the last ten years was performed using Medline and Pubmed databases, looking for "giant colonic diverticulum". We found 43 case reports, one case series and one review article including 135 patients. Discussion is based on the information obtained from the literature review and the particular aspects of this interesting case.

Management of the total bowel diverticular disease

The management of diverticulosis in normal conditions is well established, but in certain situations such as the large and small bowel diverticulosis coexists in the same person and throughout the intestine, which is rarely seen, the management is still controversial, varying from an expectant approach to bulk bowel resection, which can be therapeutically challenging for surgeons. It was reported here a typical case of an 50-year-old woman diagnosed with total bowel diverticulosis including ileum, duodenum and colon for 6 years, admitted in emergency because of the perforations of the diverticula. And we discussed the management of the rare cases like this. The defined perforated sections, along with the entire distal colon including the sigmoid colon were removed on surgery. In our experience, asymptomatic patients in this situation are usually treated expectantly, with surgery reserved for acute complications. On the surgery, the distal margin of resection must be located in rectum instead of sigmoid and primary anastomosis is recommended if possible.

[The current view of surgical treatment of diverticular disease]

AIM

The aim of our prospective dynamic cohort trial is the evaluation of indication for surgery for diverticular disease and the evaluation of morbidity and mortality.

MATERIAL AND METHOD

All patients operated for diverticular disease and its complications were involved in the study. The conservatively treated patients were not involved. 104 patients with diverticular disease and its complication were operated from August 2007 till July 2008.46 men and 58 women at average age of 63.9 (31-85) years were in this group. 78 patients were electively operated in noninflammatory stage of diverticular disease. 3 patients of them had colovesical or enterocolical fistulas. An elective laparoscopic colon sigmoid resection was performed by 74 patients and a laparoscopic left hemicolectomy was performed by 4 patients. An end-to-end stapled colorectal suture was performed by all patients. An excision of fistula from urinary bladder and a segment resection of small bowel were performed in the case of fistula presence. In connection with previously repeated diverticulitis attacks or after previous surgeries, adhesiolysis was performed by 23 patients. 26 patients were operated for acute complication of diverticular disease. 24 patients of this group were operated for acute diverticulitis and 2 patients for diverticular bleeding. 23 colon sigmoideum resections, 2 left hemicolectomies, and once ileocecal resection were performed. The primary bowel suture was performed by 20 patients and Hartmaruts operation was performed by 4 patients.

RESULTS

The indication for surgery follows the classification according to Hansen and Stock. The abdominal postoperative complications (wound infection, anastomotic leak, prolongated bowel atonia, and others) occurred by elective operated group in 9% and by acute operated group in 26.9%. The overall abdominal postoperative complications occurred in all the involved patients in 13.4%. The extraabdominal postoperative complications (urinary infection or retention, cardiopulmonary complications, trombosis/embolia, postoperative qualitative conscious disorder, renal insufficiency, and others) occurred by elective group in 19.6% and by acute operated group in 50%. Overall extraabdominal postoperative complications occurred in all involved patients in 26.90%. The mortality was 0%. The conversion rate in elective group was 3.8% (3 pts.). An anastomosis leak occurred once (1%) by elective operated patient. An acute reoperation with resection according to Hartmann was performed. A small bowel loop perforation by coincidental adhesiolysis occurred once. A small bowel defect was identified and sutured by early laparoscopic reoperation. The conversion rate in acute group was 23.1% (6 pts.). The colonoscopy was necessary on 3rd day by 1 patient after left hemicolectomy for splenic flexure bleeding. This examination revealed bleeding from diverticulum in hepatic flexure. An endoscopic treatment was performed. An abscess in small pelvis occurred by this patient (12th postoperative day) and open drainage was performed. There was no anastomosis leak in group with acutely operated patients.

CONCLUSION

The usage of standard classification is suitable for operation's indication for diverticular disease and its complications. It helps to determine the type and operation's strategy. The acute complicated diveticulitis has high morbidity and mortality. The early indication of selected patients with diverticular disease for elective colon sigmoideum resection protects against possible complication in the case of next attack of diverticulitis. It concerns the patients with recidivated uncomplicated and complicated forms of disease as well. The primary conservative treatment with percutaneous CT navigated drainage allows a postponed elective surgery. The primary resection with suture is better than the two stage surgery. The primary laparoscopic resection is safe procedure in almost all the cases. The primary suture can be safely performed in all elective cases for uncomplicated diverticulitis, chronic fistulas, obstruction, for primarily conservatively treated stages Hinchey I and II and possibly for all the selected patients with Hinchey III and IV stages with MPI lower as 21.

[The colonoscoy in elderly patients]

AIM

The increase in the average life led an increase of diseases, acute and chronic, not only cardiovascular and respiratory system, but also gastrointestinal. Likewise we see an increase in neoplastic lesions, sometimes diagnosed in advanced stage of disease, not susceptible to radical therapy. The purpose of this work is to evaluate the usefulness, reliability and security of colonoscopy in elderly patients, age 75 years or more. MATHERIALS END METHODS: We analysed 2407 colonoscopies, performed from January 2005 to December 2006 in Unit of Digestive Endoscopy of Gastrointestinal Surgery ("Federico II" University of Naples) and in Unit of Digestive Endoscopy of "Villa Maria Clinica" (Mirabella Eclano). Of these four hundred and sixty-nine patients (19.5%), 276 men and 139 women, were 75-years-old or more. Were considered indications to endoscopy completeness of the examination, findings, presence of any complications. In all patients were performed premedication with midazolam, 2,5-5 mg and floroglucina biidrata, 40-80 mg. The patients were constantly monitored with pulsiossimetro.

RESULTS

The colonoscopy was completed in 432/469 patients (92%). In 19 cases (4%) there was a neoplastic stenosis; other reasons for the failure of cecal intubation were the poor intestinal preparation (2.5%) and intolerance of the patient (1.5%). Were excluded patients in follow-up to previous surgery or polypectomy (33.5%). Other indications in the investigation were, in descending order, abdominal pain (32.8%), presence of anaemia (22.4%), rectal bleeding (19.2%), diarrhea or constipation (18.4%), presence of abdominal mass (72%). There were no complications observed, or local (perforation/bleeding), or general (cardio-respiratory or neurological). Most frequent findings were: diverticoular disease (34.4%), polyps (22.4%), cancer (12.8%), find colitis also aspecific (10.4%), hemorrhoids (8.8%). In 11.2% of patients colonoscopy was negative.

CONCLUSION

The endoscopic examination of the gastrointestinal tract is now practiced daily in almost all hospitals. The advanced age of patient, with the possible presence of diseases associated is not, in our opinion, a controindication. Although present in the literature trials that emphasize the possibility of a higher incidence of complications in elderly patients, our experience shows how this control is quite safe, if executed in appropriate and correct manner, thanks also to appropriate preparation/sedation and monitoring of the patient. Compared to other diagnostic methods, such as air contrast barium enema, the computed tomography and virtual colonoscopy, "traditional" colonoscopy has the undoubted and decisive advantage of being able to run biopsies, and complete removal of the lesion, as in the case of polypectomy. In our case we have seen a high number of elderly patients, well 469/2407, equivalent to 19.5%. A neoplastic lesion was found in 165 patients (35.2%) and of these over 80% has successfully received curative treatment (surgery or polipectomy).

Colonic diverticular bleeding with comorbid diseases may need elective colectomy

BACKGROUND

Colonic diverticular bleeding can usually be managed with conservative treatment. However, in a selected group of patients under conditions of recurrent, persistent bleeding influencing quality of life or causing life-threatening shock, it should be managed with surgery. This is a retrospective study to clarify the risk factors relating to colectomy for colonic diverticular bleeding.

METHODS

Between 1997 and 2005, a retrospective chart review of 73 patients with colonic diverticular bleeding was undertaken. Univariate and multivariate logistic regression analyses were performed to identify the relevant risk factors correlating to colectomy.

RESULTS

The mean age of the 73 patients was 70 years (range, 22-90 years). Most colonic diverticular bleeding could be managed with conservative treatment (n = 63, 86.3%), and urgent colectomy was performed in ten patients (13.7%). The bleeding site could not be well identified in six of those ten patients and so underwent total abdominal colectomy with ileorectal anastomosis, and the other four underwent right hemicolectomy after a diagnosis of right-sided colon diverticula with bleeding. There were two deaths in the surgical group and one death in the nonsurgical group. The overall mortality rate in the series was 4.11% and 20% among patients undergoing urgent colectomy. Multiple logistic regression analysis showed that the presence of comorbidities and daily maximum blood transfusion requirement were risk factors for urgent colectomy for colonic diverticular bleeding.

CONCLUSION

Preoperative comorbid diseases may increase operative risk in urgent surgery, and the outcome is poor. To avoid high mortality and morbidity relating to the urgent colectomy, we suggest that patients of colonic diverticular bleeding with comorbid diseases, especially subgroups of patients with diabetes and gouty arthritis, may need early elective colectomy.

[Colonic diverticulosis: which patients need surgery?]

Diverticular disease has become a very common condition in elder and more recently in younger patients in western countries that emerged at the turn of the 20th century and since then has become epidemic. An increasing incidence and an earlier onset of the disease lead us to update the current therapeutic indications, especially for surgery in elective condition. Whereas elective colectomy was performed for poorly documented suspicions of diverticulitis in the past, a positive diagnosis of diverticulitis on CT scan is needed. Therefore, indications for colectomy are restricted to patients with medical history of related endocarditis, diabetes mellitus, proven structural abnormalities of collagen, immune deficiency, after a second episode of diverticulitis requiring at least an hospitalisation or after a single complicated diverticulitis (abscess, fistula, stricture). A two-months delay between symptoms and surgery is suitable, and permits to perform preoperatively a colonoscopy in a safe condition to rule out concomitant adenoma or colonic cancer. There is no randomised trial of open versus laparoscopic colectomy in this specific indication. As the lesions of resected colon became more severe due to restricted indications, laparoscopic approach will require more surgical skill and conversion rate might increase. In selected cases, open surgery should be preferred.

Giant sigmoid diverticulum: a case report

OBJECTIVES

To report an unusual presentation of a giant sigmoid diverticulum in the colon.

CLINICAL PRESENTATION AND INTERVENTION

The patient presented with an abdominal mass, altered bowel habits, and increasing weight. The provisional diagnosis was made by barium enema and CT scan. The patient underwent laparotomy, revealing a perforated giant sigmoid diverticulum that was excised using Hartmann's procedure. The perforation could have been precipitated by the barium enema study. The histopathology of the resected specimen revealed giant sigmoid diverticulum with no evidence of malignancy.

CONCLUSION

CT scan was adequate for diagnosis of the suspected giant sigmoid diverticulum. Surgical intervention was successfully used to excise the diverticulum.

Health-related quality of life after colonic resection for diverticular disease: long-term results

BACKGROUND AND AIMS

While colonic resection is standard practice in complicated colonic diverticular disease (DD), treatment of uncomplicated diverticulitis is, as yet, unclear. The aim of the present study was to evaluate the long-term clinical outcome and quality of life in DD patients undergoing colonic resection compared to those receiving medical treatment only.

PATIENTS AND METHODS

Seventy-one consecutive patients who were admitted to our surgical department with left iliac pain and endoscopical or radiological diagnosis of DD were enrolled in this trial. Disease severity was assessed with Hinchey scale. Twenty-five of the patients underwent colonic resection, while 46 were treated with medical therapy alone. After a median follow-up of 47 (3-102) months from the time of their first hospital admission, the patients responded to the questions of the Cleveland Global Quality of Life (CGQL) questionnaire and to a symptoms questionnaire during a telephone interview. Admittance and surgical procedures for DD were also investigated, and surgery- and symptoms-free survival rates were calculated. Nonparametric tests and survival analysis were used.

RESULTS

The CGQL total scores and symptom frequency rate were found to be similar in the two groups (resection vs nonresection). Only current quality of health item was significantly worse in patients who had undergone colonic resection (p = 0.05). No difference was found in the rate and in the timing of surgical procedures and hospital admitting for DD in the two groups. In particular, the nine patients classified as Hinchey 1 who underwent surgery reported the same quality of life, symptoms frequency, operation, and hospital admitting rate as those who had been admitted with the same disease class but who received medical treatment only.

CONCLUSIONS

Our results indicate that there does not seem to be any long-term advantage to colonic resection which should be considered only in patients presenting complicated DD.

[Diverticulosis of the colon end its complications under the mask of emergency surgical abdomen--10 years experience]

OBJECTIVES

estimating the prevalence of colonic diverticulosis and its complications studied at the clinic for 10-years period as well as the approaches for its operative treatment and analysis of the subsequent results. CASES AND APPROACHES: During the period 1998-2008 56 patients were hospitalized (31 women and 25 men) at the Surgical department of the University hospital "Alexandrovska". They had different forms of colonic diverticulosis. The average age of the patients was 66.7. The retrospective analysis divides the patients into three clinical groups: 1st group--peritonitis and pericolic abscess caused by diverticulosis--present in 49 patients. 2nd group--chronic non-specific inflammatory infiltrate and fistula--present in 5 patients. 3rd group--severe haemorrhage and anaemic syndrome--present in 2 patients

RESULTS

Mortality-rate is 12.5% (7 patients). 10 patients with complications were registered--5 with suppuration of the surgical wound and 5 with pneumonia and pleural effusion.

CONCLUSION

Colonic diverticulosis is a disease of great surgical interest because of its complicated forms requiring conventional or surgical treatment. Various forms of peritonitis which are part of the emergency surgical abdomen domain are relatively frequent complication of the gastrointestinal (in particular of the colon) diverticulosis. They are difficult to diagnose in the pre-operative period and its not easy to take a decision about the particular operative approach. All that is related with the relatively high morbidity and mortality.

Health-related quality of life after colonic resection for diverticular disease: long-term results

BACKGROUND AND AIMS

While colonic resection is standard practice in complicated colonic diverticular disease (DD), treatment of uncomplicated diverticulitis is, as yet, unclear. The aim of the present study was to evaluate the long-term clinical outcome and quality of life in DD patients undergoing colonic resection compared to those receiving medical treatment only.

PATIENTS AND METHODS

Seventy-one consecutive patients who were admitted to our surgical department with left iliac pain and endoscopical or radiological diagnosis of DD were enrolled in this trial. Disease severity was assessed with Hinchey scale. Twenty-five of the patients underwent colonic resection, while 46 were treated with medical therapy alone. After a median follow-up of 47 (3-102) months from the time of their first hospital admission, the patients responded to the questions of the Cleveland Global Quality of Life (CGQL) questionnaire and to a symptoms questionnaire during a telephone interview. Admittance and surgical procedures for DD were also investigated, and surgery- and symptoms-free survival rates were calculated. Nonparametric tests and survival analysis were used.

RESULTS

The CGQL total scores and symptom frequency rate were found to be similar in the two groups (resection vs nonresection). Only current quality of health item was significantly worse in patients who had undergone colonic resection (p = 0.05). No difference was found in the rate and in the timing of surgical procedures and hospital admitting for DD in the two groups. In particular, the nine patients classified as Hinchey 1 who underwent surgery reported the same quality of life, symptoms frequency, operation, and hospital admitting rate as those who had been admitted with the same disease class but who received medical treatment only.

CONCLUSIONS

Our results indicate that there does not seem to be any long-term advantage to colonic resection which should be considered only in patients presenting complicated DD.

Incidence and risk factors of recurrence after surgery for pathology-proven diverticular disease

Background

Diverticular disease is a common problem in Western countries. Rationale for elective surgery is to prevent recurrent complicated diverticulitis and to reduce emergency procedures. Recurrent diverticulitis occurs in about 10% after resection. The pathogenesis for recurrence is not completely understood. We studied the incidence and risk factors for recurrence and the overall morbidity and mortality of surgical therapy for diverticular disease.

Methods

Medical records of 183 consecutive patients with pathology-proven diverticulitis were eligible for evaluation. Mean duration of follow-up was 7.2 years. Number of preoperative episodes, emergency or elective surgeries, type of operation, level of anastomosis, postoperative complications, persistent postoperative pain, complications associated with colostomy reversal, and recurrent diverticulitis were noted. The Kaplan-Meier method was used to calculate the cumulative probability of recurrence. Cox regression was used to identify possible risk factors for recurrence.

Results

The incidence of recurrence was 8.7%, with an estimated risk of recurrence over a 15-year period of 16%. Risk factors associated with recurrence were (younger) age (p < 0.02) and the persistence of postoperative pain (p < 0.005). Persistent abdominal pain after surgery was present in 22%. Eighty percent of patients who needed emergency surgery for acute diverticulitis had no manifestation of diverticular disease prior to surgery. In addition, recurrent diverticulitis was not associated with a higher percentage of emergency procedures.

Conclusion

Estimated risk of recurrence is high and abdominal complaints after surgical therapy for diverticulitis are frequent. Younger age and persistence of postoperative symptoms predict recurrent diverticulitis after resection. The clinical implication of these findings needs further investigation. The results of this study support the careful selection of patients for surgery for diverticulitis.

Minimally invasive techniques in colon surgery

With the description of the first laparoscopic cholecystectomy in 1985, minimally invasive approaches have become the standard practice of surgeons in managing several disease processes. This has been mainly driven by the significant favorable impact of minimally invasive surgery on patient related outcomes. Smaller incisions lead to improved cosmesis, reduced postoperative pain and earlier return of gastrointestinal function. These factors in turn contribute to a faster recovery of the patient (compared to similar open procedures) with a reduced utilization of hospital resources, reduced costs and earlier return of the patient to normal routines of daily life and work. With experience it is clear that these favorable patient outcomes can also be seen with minimally invasive surgery for various colonic diseases and procedures. Many of the early concerns regarding minimally invasive approaches such as port site recurrence and the feasibility of adequate oncologic resections have been laid to rest by multiple randomized trials. There are now documented benefits to minimally invasive approaches for colonic diseases such as cancer, inflammatory bowel disease and diverticular disease; as long as surgeons choose the appropriate patients and spend the time and resources needed to become proficient at these advanced procedures.

[Indications and limits of laparoscopic treatment for diverticular disease of the colon: personal experience]

The aim of the study was to evaluate the role of laparoscopic surgery in diverticular disease of the colon, in the experience of a specialized centre. Sixty-seven patients were observed from November 2004 to March 2006 at the Robert Koch Krankenhaus of Gehrden (Hannover) with a diagnosis of acute diverticulitis, chronic diverticulitis and/or complications and submitted to elective or emergency surgery. The mean operating time was 171.5 minutes for the laparoscopic approach, and 142.7 minutes for open surgery. Return to normal bowel function occurred after 3.7 days for laparoscopy, as against 4.4 days for open surgery. Mean hospital stay was 9.8 days for the laparoscopic approach and 16.3 days for open surgery. Morbidity was 18.6% (8 cases) in the laparoscopic group and 25% (6 cases) in the open group. Mortality was 0%. Re-operation was necessary in 5 cases in the laparoscopic group (11.6%) and in 4 cases (16.6%) in the open group. Laparoscopy is an important innovation in the surgical treatment of diverticular disease. This approach should be assessed in relation to patient characteristics, medical history and clinical presentation. The advantages of laparoscopy are shorter postoperative hospital stay, less postoperative pain, earlier discharge, better cosmetic result, less blood loss and less peritoneal contamination. In the advanced stages of disease open surgery still remains very important.

Inflammation and perforation of a solitary diverticulum of the cecum. A report of 5 cases and literature review

Solitary diverticulum of the cecum is a benign condition uncommon in the Western world, and with a higher incidence in Asian population. They are usually asymptomatic, and manifest clinically only with complications such as inflammation, perforation, or bleeding. They are a rare cause of acute abdominal pain, clinically similar to acute appendicitis, with tenderness in the right lower quadrant, fever, and leukocytosis. In spite of the information provided by ultrasonography or CT scans, a correct preoperative diagnosis is still difficult to reach, and is usually arrived at in the operating theater; differentiation from a neoplasm may be also sometimes complicated, and a wide surgical resection is usually required for such cases. We report on 5 cases of inflammation and perforation of a solitary cecal diverticulum, and perform a literature review.

[Covered perforation of solitary cecal diverticulum: case report]

Acute right lower abdominal pain is often clinically difficult to diagnose. The diagnosis, especially in young patients, is frequently oriented to appendicular disease. Surgical exploration only confirms diagnosis or surprises the surgeon, revealing an unexpected right colon diverticulitis. This emergency condition challenges the surgeon with the dilemma about the best therapeutic choice: conservative or radical treatment? The elective localization of diverticulitis to the right colon is very rare (6.6-14%). The authors report a case of covered perforation of a solitary cecal diverticulum.

A giant sigmoid diverticulum presenting as an upper abdominal mass

AIM

We report a case of a giant diverticulum of the sigmoid colon presenting as a mass in the left upper quadrant of the abdomen in an elderly man.

METHODS

This report highlights a rare complication of diverticular disease. At operation, the giant cyst was situated in the supracolic compartment of the abdomen. The management options and a review of the literature are presented.

CONCLUSION

CT scan is the investigation of choice. Early surgical intervention is important in order to reduce the risk of perforation.

Outcomes of right- compared with left-side colectomy

Right colon resections are perceived as less morbid than left colon resections. The purpose of this study was to determine the differences in outcomes between right-and left-side colon resections. We reviewed 420 consecutive open colectomies over 4 years. Patient demographics, surgical indications, intraoperative variables, and outcomes were collected. Two hundred twenty-three right colectomies (RCs) were compared with 197 left colectomies (LCs). RCs were more often required for cancer (111 vs 65, P < .001) and LCs for diverticular disease (10 vs 90, P < .001). LCs were more often performed emergently (36% vs 23%, P = .004) and required longer mean operative times (149 minutes vs 130 minutes, P = .004). Complications and mortality in the two groups were equal statistically. In the emergent colectomy subset, LCs were associated with greater intraoperative blood loss (315 vs 201 mL, P = .02) but fewer complications (11% vs 17%, P = .003).