Subtotal colectomy in the treatment of acute malignant left-sided large bowel obstruction.

Background: The goal of this study is to evaluate our long-term experience with the decision of optimal urgent surgical treatment.

Methods: This study is a retrospective analysis and comparison of patients with acute left-sided malignant bowel obstruction and results after staged or single-stage operations. All hospital records of patients undergoing stage or one-stage surgical procedures in the la 10-year period (1998-2007) were analyzed considering the severity of illness, postoperative morbidity and mortality, reoperations, hospital stay, quality of life and long term results of surgical treatment.

Results: There were 99 men and 86 women with the median age 66 years (range 35-88 years). Subtotal colectomy (SCE) as one-stage procedure weas performed in 85 (45.9%) of patients. Two-stage procedures required re-operations in 21% vs 3.5% in SCE group, postoperative morbidity was 19.0% vs 5.9%, the average hospita I stay was 21 vs 16 days.

Conclusion: Authors consider SCE foran optimal urgent surgical method for treatment of acute malignant left-sided large bowel obstruction for the next reasons: it is a one-stage procedure in decompensated bowel obstruction with generally acceptable postoperative morbidity, allowing an effective elimination of the "third space", detoxication of the patient, making it possible to eliminate definitively the malignancy with a minimal impairment of patients life comfort (Fig. 2, Tab. 2, Ref. 12). Full Text (Free, PDF) www.bmj.sk.