Our experience in the management of obstructing XXXX .

@entity1 @entity5 @entity254 @entity694 @entity14 @entity204
AIM: Comparing the different possible surgical procedures and the results in urgent/emergency and in elective surgery for obstructing @entity14 . MATERIAL OF STUDY: From 2008 we operated on 238 @entity1 affected by @entity14 , 115 obstructing and 19 perforated. 23 @entity1 had right-sided and 92 left-sided obstructing @entity5 , divided retrospectively in 4 groups. 18 decompressive colostomy; 32 two-stages procedures: 25 Hartmann's operations and 7 total colectomies with terminal ileostomy; 7 one-stage procedures, with defunctioning ileostomy: 4 total colectomies and 3 colonic resections with wash-out; 35 one-stage procedures with primary @entity254 +wash-out or milking. RESULTS: Operative mortality is 7% in urgent/emergency versus 1% in elective surgery and anastomotic leakage affected 6 /58 cases, 5 requiring additional surgery. Overall, about 2/3 of the perioperative @entity204 were related to general complications and 1/3 to anastomotic failure. The local recurrence rate was 7% in elective and 11% in urgent/emergency surgery. DISCUSSION AND CONCLUSIONS: Obstructing @entity14 is associated with a high operative mortality and a worse prognosis, in terms of recurrence and survival. Actually, immediate resection with primary @entity254 represents the goldstandard in selected @entity1 with a low anaesthetic risk, performing either as a typical resection with wash-out, or a subtotal colectomy; a temporary defunctioning colostomy or ileostomy could be proposed for @entity1 with an intermediate risk; in high-risk cases, advanced obstruction, simultaneous @entity694 , metastatic or locally advanced disease, Hartmann's operation should be used, as a safer procedure. Colon stenting can be an useful palliative or bridge-to-surgery option. KEY WORDS: Bowel obstruction, @entity14 , Primary @entity254 .
