Purpose
Patients on renal replacement therapy are reported to have a high complication rate after abdominal surgery, the result of uremia and immunosuppression. A review of this group of patients undergoing colorectal surgery was undertaken.
Methods
Seventy-three separate colorectal operations were performed for 44 patients. Thirty-eight patients were on dialysis and 35 had a renal transplant. Data (coexisting disease, preoperative blood results, operative details, complications, and colorectal POSSUM score) were completed for each surgical event.
Results
Forty-two elective and 31 emergency procedures were performed. Infective complications were common (overall 60 percent). There were two anastomotic leaks in the elective group, but five leaks from seven emergency anastomoses. Stomas were frequently raised. Ninety percent of patients who survived and had a defunctioning stoma underwent a successful reversal. The overall major complication rate after elective and emergency surgery was 19 and 81 percent, respectively, and mortality was 5 and 26 percent, respectively.
Conclusions
Renal patients have a high rate of complications after colorectal surgery, and emergency surgery has a significant risk of anastomotic leak. Primary anastomosis should be avoided in all patients undergoing emergency intestinal resections. Subsequent surgery to restore intestinal continuity is possible in 90 percent of patients with far fewer complications.
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References
Matas AJ, Simmons RL, Kjellstrand CM, Buselmeier TJ, Najarian JS. Increased incidence of malignancy during chronic renal failure. Lancet 1975;1:883–6.
Miach PJ, Dawborn JK, Xipell J. Neoplasia in patients with chronic renal failure on long-term dialysis. Clin Nephrol 1976;5:101–4.
Webster AC, Craig JC, Simpson JM, Jones MP, Chapman JR. Identifying high risk groups and quantifying absolute risk of cancer after kidney transplantation: a cohort study of 15,183 recipients. Am J Transplant 2007;7:2140–51.
Zeier M, Hartschuh W, Wiesel M, Lehnert T, Ritz E. Malignancy after renal transplantation. Am J Kidney Dis 2002;39:E5.
Haimov M, Glabman S, Schupak E, Neff M, Burrows L. General surgery in patients on maintenance hemodialysis. Ann Surg 1974;179:863–7.
Schreiner GE, Maher JF. The patient with chronic renal failure and surgery. Am J Cardiol 1963;12:317–23.
Borlase B, Simon JS, Hermann G. Abdominal surgery in patients undergoing chronic hemodialysis. Surgery 1987;102:15–8.
Toh Y, Yano K, Takesue F, et al. Abdominal surgery for patients on maintenance hemodialysis. Surg Today 1998;28:268–72.
Hata M, Remmers A Jr, Lindley JD, Sarles HE, Fish JC. Surgical management of the dialysis patient. Ann Surg 1973;178:134–7.
Bender JS, Ratner LE, Magnuson TH, Zenilman ME. Acute abdomen in the hemodialysis patient population. Surgery 1995;117:494–7.
Benoit G, Moukarzel M, Verdelli G, et al. Gastrointestinal complications in renal transplantation. Transpl Int 1993;6:45–9.
Franko J, Bober J, Frankovicova M, et al. Gastrointestinal surgical complications after kidney transplantation. Rozhl Chir 2002;81:475–80.
Sarkio S, Halme L, Kyllonen L, Salmela K. Severe gastrointestinal complications after 1,515 adult kidney transplantations. Transpl Int 2004;17:505–10.
Lederman ED, Conti DJ, Lempert N, Singh TP, Lee EC. Complicated diverticulitis following renal transplantation. Dis Colon Rectum 1998;41:613–8.
Carson SD, Krom RA, Uchida K, Yokota K, West JC, Weil R 3rd. Colon perforation after kidney transplantation. Ann Surg 1978;188:109–13.
Church JM, Braun WE, Novick AC, Fazio VW, Steinmuller DR. Perforation of the colon in renal homograft recipients. Ann Surg 1986;203:69–76.
Pourfarziani V, Mousavi-Nayeeni SM, Ghaheri H, et al. The outcome of diverticulosis in kidney recipients with polycystic kidney disease. Transplant Proc 2007;39:1054–6.
Sutton R, Bann S, Brooks M, Sarin S. The surgical risk scale as an improved tool for risk-adjusted analysis in comparative surgical audit. Br J Surg 2002;89:763–8.
Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 1992;111:518–26.
Connors JP, Shaw RC. Considerations in the management of open-heart surgery in uremic patients. J Thorac Cardiovasc Surg 1978;75:400–4.
Horst M, Mehlhorn U, Hoerstrup SP, Suedkamp M, de Vivie ER. Cardiac surgery in patients with end-stage renal disease: 10-year experience. Ann Thorac Surg 2000;69:96–101.
Blum U, Skupin M, Wagner R, Matheis G, Oppermann F, Satter P. Early and long term results of cardiac surgery in dialysis patients. Cardiovasc Surg 1994;2:97–100.
Self M, Dunn E, Cox J, Brinker K. Managing breast cancer in the renal transplant patient: a unique dilemma. Am Surg 2006;72:150–3.
Wind P, Douard R, Rouzier R, Berger A, Bony C, Cugnenc PH. Abdominal surgery in chronic hemodialysis patients. Am Surg 1999;65:347–51.
Pinson CW, Schuman ES, Gross GF, Schuman TA, Hayes JF. Surgery in long term dialysis patients. Experience with more than 300 cases. Am J Surg 1986;151:567–71.
Remuzzi G. Bleeding disorders in uremia: pathophysiology and treatment. Adv Nephrol Necker Hosp 1989;18:171–86.
Starnes HF Jr, Lazarus JM, Vineyard G. Surgery for diverticulitis in renal failure. Dis Colon Rectum 1985;28:827–31.
George A, Tokars JI, Clutterbuck EJ, Bamford KB, Pusey C, Holmes AH. Reducing dialysis associated bacteraemia, and recommendations for surveillance in the United Kingdom: prospective study. BMJ 2006;332:1435.
Nayman J. Effect of renal failure on wound healing in dogs. Response to hemodialysis following uremia induced by uranium nitrate. Ann Surg 1966;164:227–35.
Bakir N, Surachno S, Sluiter WJ, Struijk DG. Peritonitis in peritoneal dialysis patients after renal transplantation. Nephrol Dial Transplant 1998;13:3178–83.
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Krysa, J., Patel, V., Taylor, J. et al. Outcome of Patients on Renal Replacement Therapy after Colorectal Surgery. Dis Colon Rectum 51, 961–965 (2008). https://doi.org/10.1007/s10350-008-9225-4
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DOI: https://doi.org/10.1007/s10350-008-9225-4