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Colorectal Dis. 2018 Dec 26. doi: 10.1111/codi.14543. [Epub ahead of print]

Comparison of recovery and outcome after left and right colectomy.

Author information

1
Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA.
2
Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland.
3
Hospital Pharmacy Services, Mayo Clinic, Rochester, MN, USA.

Abstract

AIM:

The present study aimed to compare functional recovery and surgical outcomes after left and right colectomies.

METHOD:

Consecutive elective left and right colon resections for benign and malignant indications, performed between 2011 and 2016 and recorded in a prospectively maintained enhanced recovery database, were analysed. Demographic and surgical items, as well as functional recovery and 30-day complications, were compared between left-sided and right-sided colectomies. Multivariable analysis was performed to identify risk factors for postoperative ileus (POI).

RESULTS:

In total, 1001 left and 1041 right colectomies were comparable regarding demographic factors; only body mass index (BMI) was higher in patients undergoing left-sided resections (> 30 kg/m2 : 33% vs 27%, P = 0.004). Malignancy (29% vs 67%, P < 0.001) and Crohn's disease (1% vs 31%, P < 0.001) were preponderant in right colectomies, whereas diverticular disease (68% vs 1%, P < 0.001) was the most common indication for left colectomy. Compliance with the enhanced recovery pathway (ERP) was comparable. While the minimally invasive approach was the preferred approach for both sides (61% vs 64%, P = 0.158), left colectomies took longer (180 ± 80 min vs 150 ± 70 min, P < 0.001), needed more perioperative fluids (3.1 ± 1.4 l vs 2.7 ± 1.5 l, P < 0.001) and resulted in greater postoperative weight gain (3.9 ± 6.5 kg vs 2.6 ± 6 kg, P = 0.025). Crohn's disease (OR = 2.64, 95% CI: 1.27-5.46) and fluid overload (OR = 2.02, 95% CI: 1.06-3.82) were independent risk factors for POI.

CONCLUSION:

Despite equal ERP compliance, postoperative ileus was higher after right-sided colectomies. This finding was associated with Crohn's disease and fluid overload.

KEYWORDS:

Crohn's; Enhanced recovery; colectomy; ileus; outcome

PMID:
30585680
DOI:
10.1111/codi.14543

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