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Emergency Stomas; Should Non-colorectal Surgeons be doing it?

Adnan Qureshi, Joanne Cunningham, Teresa William, Anil Hemandas




Aim: The aim of this study was to compare general and stoma specific short term complications in patients having stoma surgery in
either an emergency or elective setting during their index hospital stay. It also compares the complications specific to a stoma carried
out by surgeons with or without a specialist interest in colorectal surgery.
Background: The stoma created in emergency surgery has a high short and long term complication rate. Emergency stomas where
the site has not been marked preoperatively by a stoma therapist are more prone to complications. These complications may severely
affect a patient’s quality of life.
Methods: We retrospectively analysed data for all non-urological stomas created over the last three years in our institute. This
covered the period from January 2014 to January 2017. The stoma care department kept a full database record of all patients. Besides
demography we analysed the type of stoma i.e. colostomy or ileostomy, indications for the stoma, most common operation, length of
stay (LOS) and short term complications based on the Clavien-Dindo classification. We also analysed the perioperative stoma related
complications within the emergency cohort.
Results: A total of 199 patients had new ostomies created during the three-year period. Four patients died during the inpatient stay
and were excluded from the analysis. The total number of stomas created in the emergency cohort was 60 and 135 stomas were
elective procedures. The male to female ratio was 1:1.01. The average age for the emergency cohort was 6 years older than for the
elective cohort. There was a statistically significant difference in length of stay between the two cohorts (T Test P Value =.02). There
was a higher number of elective patients discharged in the first week compared to the emergency surgery patients. The rate of grade 3
or 4 complications was higher in the emergency cohort of patients. The rate of grade 3 or 4 complications was also much higher in
patients operated by surgeons who did not have a specialist interest in colorectal surgery. The majority of grade 3 complications seen
in the emergency surgery cohort and operated on by non-colorectal specialists (NCS) were stoma related, i.e retraction, necrosis and
Conclusion: Emergency surgery procedures are frequently bowel related. Emergency stoma surgery should not be taken as trivial
procedure, non-colorectal surgeons should take advice and assistance from specialist colorectal surgeons for bowel related cases,
particularly when a stoma is involved
Keywords: Stoma, Colostomy, Non-colorectal surgeons, Hartman’s operation.
(Please cite as: Qureshi A, Cunningham J, Hemandas A. Emergency stomas; should non-colorectal surgeons be
doing it?. Gastroenterol Hepatol Bed Bench 2018;11(4):306-312).


Stoma, Colorectal surgery, complications


Shiomi A1, Ito M, Saito N, Hirai T, Ohue M, Kubo Y, Takii Y, Sudo T, Kotake M, Moriya YThe indications for a diverting stoma in low anterior resection for rectal cancer: a prospective multicentre study of 222 patients from Japanese cancer cen-tres. Colorectal Dis. 2011 Dec;13(12):1384-9. doi: 10.1111/j.1463-1318.2010.

Ulrich AB1, Seiler C, Rahbari N, Weitz J, Büchler MW..Diverting stoma after low an-terior resection: more arguments in favour. Dis Colon Rectum. 2009 Mar;52(3):412-8.

Scott NA, Jeacock J, Kingston RD. Risk factors in patients presenting as an emer-gency with colorectal cancer. Br J Surg. 1995;321-323.

Merkel S, Meyer C, Papadopoulos T, Meyer T, Hohenberger W. Urgent surgery in colon carcinoma. Zentralbl Chir. 2007;132:16–25

Wen-long Gu and Sheng-wen Wu. Meta-analysis of defunctioning stoma in low ante-rior resection with total mesorectal excision for rectal cancer: evidence based on thir-teen studies.World Journal of Surgical Oncology201513:9.

Bahattin Bayar, Kerim Bora Yılmaz, Melih Akıncı, Alpaslan Şahin, and Hakan Ku-laçoğlu. An evaluation of treatment results of emergency versus elective surgery in colorectal cancer patients. Ulus Cerrahi Derg. 2016; 32(1): 11–17.

Kwan TLLai FLam CM Population-based information on emergency colorectal sur-gery and evaluation on effect of operative volume on mortality. World J Surg2008;32 (9) 2077- 2082.

Sebastiano Biondo, MD, PhD; Esther Kreisler, MD, PhD; Monica Millan, MD, PhD; et al. Impact of Surgical Specialization on Emergency Colorectal Surgery Outcomes. Arch Surg. 2010;145(1):79-86. doi:10.1001/archsurg.2009.208.

Arumugam PJ1, Bevan L, Macdonald L, Watkins AJ, Morgan AR, Beynon J, Carr ND. A prospective audit of stomas--analysis of risk factors and complications and their management. Colorectal Dis. 2003 Jan;5(1):49-52.

Caricato M1, Ausania F, Ripetti V, Bartolozzi F, Campoli G, Coppola R. Retrospective analysis of long-term defunctioning stoma complications after colorectal surgery. Colorectal Dis. 2007 Jul;9(6):559-61.

Sebastiano Biondo, MD, PhD; Esther Kreisler, MD, PhD; Monica Millan, MD, PhD; et al. Impact of Surgical Specialization on Emergency Colorectal Surgery Outcomes. Arch Surg. 2010;145(1):79-86. doi:10.1001/archsurg.2009.208.

Goligher J Colorectal surgery as a specialty. Dis Colon Rectum 1997;40 (6) 733- 735

Constantinides VAHeriot ARemzi F Operative strategies for diverticular peritonitis: a decision analysis between primary resection and anastomosis versus Hartmann's procedures. Ann Surg 2007;245 (1) 94- 103.

Shabbir J, Britton DC. Stoma complications: a literature overview. Colorectal Dis 2010; 12: 958–964.

SPengelly, JReader, AJones, KRoper, WJDouie, and AWLambert. Methods for siting emergency stomas in the absence of a stoma therapist. Annals. Volume: 96 Issue: 3, April 2014, pp. 216-21.8

Zorcolo L1, Covotta L, Carlomagno N, Bartolo DC. Toward lowering morbidi-ty, mortality, and stoma formation in emergency colorectal surgery: the role of spe-cialization. Dis Colon Rectum. 2003 Nov;46(11):1461-7; discussion 1467-8.

Versen LHBülow SChristensen IJLaurberg SHarling HDanish Colorectal Cancer Group, Postoperative medical complications are the main cause of early death after emergency surgery for colonic cancer. Br J Surg 2008;95 (8) 1012- 1019.

Biondo SMartí-Ragué JKreisler E A prospective study of outcomes of emergency and elective surgeries for complicated colonic cancer. Am J Surg2005;189 (4) 377- 383.

DOI: https://doi.org/10.22037/ghfbb.v11i4.1397