OUTCOME OF DECOMPRESSING COLOSTOMY FOR ACUTE LEFT-SIDED COLORECTAL OBSTRUCTION
Jelle F. Huisman1, Job de Haas*2, Richard Brohet3, Wouter de Vos tot Nederveen Cappel1, Erik van Westreenen2
1Gastroenterology, Isala, Zwolle, Overijssel, Netherlands; 2Surgery, Isala, Zwolle, Netherlands; 3Epidemiology and statistics, Isala, Zwolle, Netherlands
INTRODUCTION: Traditional treatment for acute left-sided obstruction is emergency resection. However, this therapy is associated with high morbidity (32-64%) and mortality (7-35%) rates. An alternative strategy, gaining popularity, is construction of a decompressing colostomy (DC) followed by delayed resection. Aim of this study was to evaluate the postoperative outcome of DC for acute left-sided colorectal obstruction in either temporary (bridge to surgery) or palliative setting.
METHODS: In this consecutive retrospective observational cohort study, all patients with acute left-sided colorectal obstruction who underwent DC (i.e. blowhole- or loop colostomy) in the period January 2014 to July 2018 were included. Patients who underwent delayed resection after DC were allocated to the bridge to surgery (BtS) group and patients with DC as palliative treatment were allocated to the palliative group. Patient characteristics, surgical parameters, morbidity- and mortality rates and stoma related complications were analyzed. Morbidity and mortality rates were defined as 30-day postoperative events.
RESULTS: A total of 59 patients were included, 34 in the BtS- group and 25 in the palliative group (Figure 1). The main cause of obstruction was colorectal cancer (n=35), followed by diverticulitis (n=16). No mortality occurred in the BtS group after DC; major morbidity was observed in 1 patient (3%) and minor morbidity in 6 patients (18%). In the palliative group, mortality occurred in 1 patient (4%), no major morbidity was observed and minor morbidity occurred in 7 patients (28%) after DC.
DC related complications occurred 21 patients (12 patients (35%) in the BtS-group and in 9 patients (36%) in the palliative group), requiring re-intervention in 5 patients (8%).
Elective resection in the BtS-group was performed in 32 (94%) patients and simultaneous colostomy reversal was performed in 7 of these patients (22%). No mortality and major morbidity occurred in these patients and minor morbidity was observed in 7 patients (22%). The probability of restored gastrointestinal continuity was 77% in the BtS group. Four patients received an end colostomy, 2 retained the DC and 2 will probably be reversed in near future.
CONCLUSION: Colonic DC followed by elective resection is an effective alternative to acute resection in patients with all types of acute left-sided obstruction with less mortality and morbidity and high stoma reversal rate. In patients with non-curable disease, colonic decompression with primary end colostomy construction or stent placement might be the preferred treatment because of the high DC related complications with subsequent negative impact on quality of life.
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