Primary Anastomosis After Left Colectomy in Emergency Cases: Clinical Trial.

Abstract

Background: Colorectal cancer ranks as the third most prevalent cancer globally and the second leading cause of cancer-related deaths. Obstruction, a common complication in advanced cases, often necessitates emergency surgical intervention. Traditional multi-stage procedures such as Hartmann’s operation are widely used but carry significant morbidity and impact on quality of life.  

Objective: to assess the results of primary anastomosis after left colectomy for obstructing mass in emergency cases regarding early post operative complications like surgical site infection, ileus, incidence of leakage, restoration of bowel movement, hospital stay and rate of readmission within one month from the time of intervention.

Patients and Methods: This one-arm clinical trial was conducted at Ain Shams University Hospitals over 12 months, involving 37 patients with obstructing left colon masses. All underwent left colectomy with primary hand-sewn anastomosis. Patients were carefully selected based on intraoperative findings (good vascularity, absence of sepsis or perforation). Data were collected on postoperative recovery, complications, and hospital stay. 

Results: Anastomotic leakage occurred in 3 patients (8.1%), surgical site infections in 7 patients (18.9%), ileus in 5 patients (13.5%), and readmissions in 3 patients (8.1%). Bowel movement was restored in 86.5% of patients within three days. Mean hospital stay was 7.2 ± 1.2 days. No perioperative mortality was recorded.

Conclusion: Primary anastomosis after emergency left colectomy is a safe and viable option in selected patients. When performed by experienced surgeons and guided by strict intraoperative criteria, it offers favorable short-term outcomes and avoids the need for stoma formation.