Annals of Coloproctology

Original Article

Benign GI diease

Prognostic Factors and Management for Left Colonic Perforation: Can Hartmann’s Procedure Be Preventable?: Yilseok Joo, Yujin Lee, Taeyoung Yoo, Jungbin Kim, Inseok Park, Geumhee Gwak, Hyunjin Cho, Keunho Yang, Kiwhan Kim, Byung-Noe Bae; Ann Coloproctol. 2020;36(3):178-185. Published online June 30, 2020; DOI: https://doi.org/10.3393/ac.2019.11.14.1

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Purpose
To identify factors significantly associated with the mortality of patients with left colonic perforation, and to compare the outcome of Hartmann’s procedure (HP) and primary repair (PR) or primary anastomosis (PA) in patients with left colonic perforation without factors associated with mortality.
Methods
This retrospective study included patients who underwent surgery for left colonic perforation from January 2009 to February 2018. Preoperative factors related to postoperative mortality, including vital signs, laboratory findings, and intraoperative findings, were analyzed by type of operation. The chi-square, Fisher exact, and Mann-Whitney U-tests were used to analyze the data.
Results
Ninety-one patients were included (36 men, 55 women), and 15 (16.5%) died postoperatively. Prognostic factors were age, leukopenia, thrombocytopenia, bleeding tendency, acute kidney injury, hemodynamic instability, and the existence of feculent ascites. Leukopenia and longer operative time were independent risk factors for mortality. Seventy-nine patients did not have leukopenia and 30 of these patients who underwent PR without diversion were excluded from the subanalysis. HP was performed in 30 patients, and PR with diversion and PA with or without diversion were performed in 19. Compared to the other operative methods, HP had no advantage in reducing hospital mortality (P=0.458) and morbidity.
Conclusion
Leukopenia could be an objective prognostic factor for left colonic perforation. Although HP is the gold standard for septic left colonic perforation, it did not improve the hospital mortality of the patients without leukopenia. For such patients, PR or PA may be suggested as an alternative option for left colonic perforation.

Citations

Citations to this article as recorded by

Risk Factors for Postoperative Major Morbidity, Anastomotic Leakage, Re-Surgery and Mortality in Patients with Colonic Perforation
Maximilian Brunner, Lara Gärtner, Andreas Weiß, Klaus Weber, Axel Denz, Christian Krautz, Georg F. Weber, Robert Grützmann
Journal of Clinical Medicine.2024; 13(17): 5220. CrossRef
Evaluation of Morbidity and Mortality in Iatrogenic Colonic Perforation During Colonoscopy: A Comprehensive Systematic Review and Meta-Analysis
Ajibola A Adebisi, Daniel E Onobun, Adeola Adediran, Reginald N Ononye, Ethel O Ojo, Adedayo Oluyi, Ayotunde Ojo, Stephen Oputa
Cureus.2024;[Epub] CrossRef
Patient outcomes and prognostic factors associated with colonic perforation surgery: a retrospective study
Do-bin Lee, Seonhui Shin, Chun-Seok Yang
Journal of Yeungnam Medical Science.2022; 39(2): 133. CrossRef
Morbidity and Mortality of Neutropenic Patients in Visceral Surgery: A Narrative Review
Ann-Kathrin Lederer, Fabian Bartsch, Markus Moehler, Peter Gaßmann, Hauke Lang
Cells.2022; 11(20): 3314. CrossRef

Original article

WITHDRAWN: Risk factors and management for left colonic perforation: Yilseok Joo, Yujin Lee, Taeyoung Yoo, Jungbin Kim, Inseok Park, Geumhee Gwak, Hyunjin Cho, Keunho Yang, Kiwhan Kim, Byung-Noe Bae; Received September 2, 2019 Accepted November 14, 2019 Published online January 31, 2020; DOI: https://doi.org/10.3393/ac.2019.11.14

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