Abstract:

OBJECTIVE: This study aims to compare the efficacy of total-subtotal colectomy and primary anastomosis with the other methods used in obstructive malignant lesions of the letf colon. METHODS: We retrospectively scanned the patients who had obstruction symptoms and underwent emergency operation during the last five years. We recorded the level of obstruction, the operating technique, operating time, hospital stay, postoperative mortality and morbidity. Additionally, we calculated the cost of each patient according to the list of Social Security Institution. The data was analised by using SPSS (statistical package for social sciences) version 15.0. RESULTS: The number of patients underwent emergency operation due to malignant colonic obstruction was 28 and their median age was 62. The 11 of 20 patients included to the study were underwent subtotal-total colectomy and primary anastomosis (ileoproctostomy or ileocolostomy) (group 1). In the second group 4 patients were underwent Hartmann procedure, 5 were underwent resection and primary anastomosis. There were no statistically significant difference in terms of age, gender, tumor stage and co-morbidities. The mean hospital stay was 8,5 days in group 1 and 14,2 days in group 2. The difference is remarkeble but not statistically significant. The mortality rate was 9% in group 1 and 22% in group 2 (p>0.05). There was a case (9%) with anastomosis leak in group 1. The mean cost was 6552 TL in group 1 and 9424 TL in group 2 (P<0.05). Total mortality rate was 15% (n=3) and morbidity rate was 30% (n=6). CONCLUSION: In malignant obstruction of left colon, subtotal-total colectomy with primary anastomosis has shorter hospital stay and found to be cheaper. As the malignant obstruction tumors of left colon has the risk of synchron tumor-polyp, in experienced hands subtotal-total colectomy with primary anastomosis is an alternative to other primary or two stage procedures.

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