One Stage Versus Two Stages Surgery in The Management of Left Colorectal Emergencies

Background: Traditionally, primary colonic anastomosis is not performed in an emergency, however, there is a current tendency toward primary anastomosis in order to avoid a second hospitalization and a second operation to reestablish intestinal continuity
Aim of the work: This study aimed to evaluate the surgical results of one-stage versus multiple-stage surgery in patients with left colorectal crises.   
Patients and methods: This prospective study was conducted on 30 patients. Fifteen patients agreed to have a one-stage primary anastomosis subtotal colectomy [group A]. Hartmann's technique was performed on the remaining 15 patients [group B]. Inoperable colorectal cancer and severe septic shock were exclusion criteria.   
Results: Males outnumbered females in both categories. Colorectal cancer was the most prevalent cause in both groups, accounting for 16 cases. Postoperative complications in group A were two [10%] cases of wound infection, three [20%] cases of prolonged ileus, two [13.3%] cases of chest infection, two [13.3%] cases of anastomotic leakage, which were managed conservatively, and closed without the need of intervention within 3 weeks, whereas in group B, there were 11 [73.4%] cases with no complication, two [13.3%] cases had wound infection, and two [13.3%] cases anastomotic leakage after Hartman’s reversal, which was also treated conservatively and closed without the need of intervention within 5 weeks. The operating time in group A was substantially less than in group B [161.87±28.015 vs. 252.53±28.648min; P 0.001]. Group A patients had a considerably shorter hospital stay than group B patients [10.53±1.959 vs. 19.93±4.114 days; P 0.001]. There is no mortality in group A, but there is one instance in group B.
Conclusion: A one-step surgical technique Subtotal colectomy for left colonic crises eliminates the inconvenience of a phased operation Hartmann's technique while reducing morbidity and mortality and offering a shorter operational time and hospital stay overall.