[Timing and results of the surgical treatment of the XXXX of the colon].

@entity1 @entity66 @entity3813 @entity4436
AIMS: To evaluate retrospectively the outcome of the curative open and laparoscopic surgical approach to the @entity66 according to timed steps based on the pathologic stage. @entity1 AND MATERIAL: From 1989 83 out of 242 outpatients underwent surgery in emergency or after medical failure and at least two acute attacks requiring hospital admittance, or complicated @entity4436 . Modified Hinchey classification staged the disease. Clinic and instrumental criteria, surgical procedures, early and late complications were statistically evaluated (Students t-test and exact Fischer test, p < 0.05) in comparison with the different steps of therapeutic strategy. RESULTS: Twenty nine @entity1 were classified as Hinchey 0, 26 as I, 14 as II, 11 as III, 3 as IV. Clinical characteristics of the @entity3813 and open groups overlapped, with higher rate of earlier age in first and advanced stages in the second group. 16 @entity1 (19.3%) underwent surgery at the first attack in emergency or in delayed emergency (5 TC-guided drainages). 30 open and 53 @entity3813 procedures were done: 21 two-stage: 18 primary resections + ileostomy and 3 Hartmann; 61 single stage: 49 sigmoidectomy, 12 left colectomy. 4 conversions (7.5%), 12 early (14.5%) and 10 late (12.1%) complications were observed. DISCUSSION: Complications rate was higher in the open group including more advanced stages. Elective surgery performed following conservative therapy, 4 weeks from the first acute attack in younger @entity1 (age < 55yrs.) and after two attacks in elder (age > 55yrs.) showed a significant lower complications' incidence (p < 0.05) compared to the 8 weeks delayed operations. CONCLUSION: Surgery of @entity4436 must follow standardized criteria. The laparoscopic approach could be performed in more severe stages, provided that conditions of delayed emergency were achieved.
