Evaluation of the Clinical Outcomes of Colostomy and Subtotal Colectomy in Patients with Paralytic Ileus Associated with Prolonged Hospitalization

Öz

Aim: Paralytic ileus secondary to prolonged hospitalization may require surgery in patients unresponsive to conservative management. Colostomy allows rapid decompression, whereas subtotal colectomy offers a more definitive solution; however, comparative evidence remains limited. Methods: We conducted a single-center retrospective study of 13 patients aged ≥65 years hospitalized for≥14 days with paralytic ileus or distension refractory to conservative therapy. Four patients underwent sigmoidostomy, and nine underwent subtotal colectomy. Primary endpoints included mortality and major morbidity, while secondary endpoints encompassed ICU and total hospital stay, time to enteral feeding, need for reoperation, and quality of life. Results: Sigmoidostomy was associated with shorter operative time (65 vs. 160 min, p<0.001), ICU stay (3 vs. 6 days, p=0.01), total hospital stay (10 vs. 18 days, p=0.01), and earlier enteral feeding (1 vs. 4 days, p=0.002). No mortality or major complications occurred in the sigmoidostomy group; subtotal colectomy had a mortality rate of 11.1% and a major complication rate of 22.2%. At six months, recurrent ileus was absent after subtotal colectomy, but mild distension recurred in the colostomy group. Quality-of-life scores were higher in the subtotal colectomy group, suggesting superior functional recovery. Conclusion: Colostomy enables faster early recovery, while subtotal colectomy may reduce recurrence and improve mid-term functional outcomes in carefully selected patients. Surgical decision-making should account for frailty, nutritional and infection status, and therapeutic goals. Prospective multicenter studies are required to validate these findings.

Anahtar Kelimeler

• Geriatric surgery
• Paralytic ileus
• Acute colonic pseudo-obstruction (Ogilvie’s syndrome)
• Colostomy
• Subtotal colectomy

Uzun Süreli Hastane Yatışına Bağlı Olarak Gelişen Paralitik İleus Hastalarında Kolostomi ve Subtotal Kolektomi Uygulamalarının Klinik Sonuçlarının Değerlendirilmesi

Öz

Amaç: Uzun süreli hastaneye yatışa bağlı gelişen paralitik ileus, konservatif tedaviye yanıt vermeyen hastalarda cerrahi müdahale gerektirebilir. Kolostomi hızlı dekompresyon sağlarken, subtotal kolektomi daha kalıcı bir çözüm sunar; ancak karşılaştırmalı kanıtlar sınırlıdır. Yöntemler: Paralitik ileus veya konservatif tedaviye dirençli distansiyon nedeniyle ≥14 gün hastanede yatan ve ≥65 yaşındaki 13 hasta ile tek merkezli retrospektif bir çalışma yaptık. Dört hastaya sigmoidostomi, dokuz hastaya subtotal kolektomi uygulandı. Primer uç noktalar mortalite ve majör morbidite iken, sekonder uç noktalar yoğun bakım ve toplam hastane yatış süresi, enteral beslenmeye başlama zamanı, reoperasyon ihtiyacı ve yaşam kalitesi olarak belirlendi. Bulgular: Sigmoidostomi, daha kısa operasyon süresi (65 vs. 160 dk, p<0,001), yoğun bakım yatış süresi (3 vs. 6 gün, p=0,01), toplam hastane yatış süresi (10 vs. 18 gün, p=0,01) ve daha erken enteral beslenme (1 vs. 4 gün, p=0,002) ile ilişkiliydi. Sigmoidostomi grubunda mortalite veya majör komplikasyon gözlenmedi; subtotal kolektomi grubunda mortalite oranı %11,1 ve majör komplikasyon oranı %22,2 idi. Altı ayda, subtotal kolektomi sonrası ileus tekrarı görülmezken, kolostomi grubunda hafif distansiyon yeniden ortaya çıktı. Yaşam kalitesi skorları subtotal kolektomi grubunda daha yüksek bulunarak, fonksiyonel iyileşmenin daha iyi olduğunu gösterdi. Sonuç: Kolostomi, erken dönemde daha hızlı iyileşme sağlarken, subtotal kolektomi tekrar riskini azaltabilir ve orta dönem fonksiyonel sonuçları iyileştirebilir. Cerrahi karar verirken, frailty (kırılganlık), beslenme ve enfeksiyon durumu ile tedavi hedefleri göz önünde bulundurulmalıdır. Bu bulguları doğrulamak için prospektif çok merkezli çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• Geriatrik cerrahi
• Paralitik ileus
• Akut kolonik psödo-obstrüksiyon (Ogilvie sendromu)
• Kolostomi
• Subtotal kolektomi

Kaynakça

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