Evaluation of Primary Colonic Anastomosis with Temporary Diverting Ileostomy for the Treatment of Left Colonic Emergencies

Background: The poor outcomes of Hartmann’s procedure have sparked interest in an alternative two-stage procedure, sigmoid resection with primary anastomosis and diverting ileostomy (DI) with later ileostomy reversal. This work aimed to assess the safety and outcomes of primary colonic anastomosis with DI in the treatment of left colonic emergencies regarding morbidity, mortality, and hospital stay.Methods: This prospective study was carried out on 20 patients over the age of 18 who presented with left colonic emergencies, either benign or malignant. All patients underwent emergency laparotomy for left colonic pathologies then a primary resection anastomosis with covering ileostomy (PADI).Results: This study showed male predominance (75%) and ASA class I (70%) to class II (30%) among the studied patients, favorable outcomes regarding pre-reversal results such as shorter hospital stay (5.4±1.50) days, minor postoperative complications classified by the Clavien Dindo classification system such as seroma (30%). Low incidence of High Output Stoma (HOS) (10%) and Stoma Outlet Obstruction (SOO) (15%). Also, favorable outcomes regarding post-stoma reversal results such as shorter time of stoma reversal (6±0.4) weeks, low incidence of anastomotic leakage (0%), manageable rates of adhesive intestinal obstruction (10%), low incidence of wound infection at stoma site (30%), no incidence of mortality. These results confirm the feasibility and safety of this surgical strategy in managing acute left colonic emergencies.Conclusions: PADI was a safe and feasible procedure for the management of left colonic emergencies a small, selected cohort with predominantly low-risk patients. This procedure is associated with a short postoperative hospital stay, low rates of post-operative complications such as seroma, early restoration of bowel continuity, low rates of anastomotic leakage, and adhesive IO.