Emergency laparotomy is a critical surgical procedure undertaken for life-threatening conditions such as bowel perforation, ischemia, or obstruction, with significant morbidity and mortality risks [1][2][3]. Surgeons must choose between two primary strategies: stoma creation or resection with anastomosis [4][5].

Stoma creation diverts fecal content through an external opening, minimizing the risk of complications like anastomotic leakage. This approach is often preferred for patients with compromised bowel viability or those who are hemodynamically unstable [6][7]. In contrast, resection with anastomosis involves removing the diseased bowel segment and reconnecting the healthy ends, aiming to restore bowel continuity [8][9]. This strategy is generally favored in stable patients, offering the benefit of maintaining normal gastrointestinal function without needing a stoma reversal surgery [10][11].

The literature offers varied outcomes for these procedures. Studies highlight the safety of stoma placement in unstable patients due to lower immediate postoperative complications, while others emphasize the long-term benefits of resection with anastomosis, particularly in restoring gastrointestinal function [12][13][14]. However, outcomes often vary based on patient demographics, comorbidities, and clinical urgency, leading to no clear consensus on the optimal approach [15][16][17].

Given the high stakes of emergency laparotomy, a detailed comparison of stoma placement versus resection with anastomosis is crucial. This study aims to examine postoperative complications, morbidity, and mortality in patients undergoing emergency laparotomy to inform clinical decision-making and improve patient outcomes in emergency surgical settings [18][19][20].

This study involved a retrospective cohort analysis of 50 patients who underwent emergency laparotomy for acute abdominal conditions at a tertiary care hospital. The patients were divided into two groups based on the procedure performed: stoma placement or resection with anastomosis. Data on demographics, preoperative conditions, intraoperative findings, and postoperative complications were collected and analyzed.

Inclusion Criteria:

- Age: ≥18 years.

- Emergency laparotomy for acute abdominal pathology.

- Procedure: stoma creation or resection with anastomosis.

- Minimum 30-day postoperative follow-up.

Exclusion Criteria:

- Age <18 years.

- Pregnant patients.

- Surgical interventions unrelated to stoma or anastomosis.

- Missing data within the 30-day follow-up period.

Table 4 Intra operative findings

The intraoperative findings played a critical role in determining the choice of procedure. Patients with viable bowel loops were more likely to undergo resection and anastomosis, reflecting its suitability for stable cases with good tissue viability. Conversely, gangrenous loops or perforations necessitated stoma placement to mitigate the risk of anastomotic leakage and other complications.

Table 6 Different post-operative complications compared both group

                The absence of anastomotic leakage in the stoma group underscores the procedural safety of stoma placement, particularly in patients with high-risk intraoperative findings. Conversely, the higher rates of wound infection and paralytic ileus in the resection group highlight its complexity and vulnerability to complications.

TABLE 7 COMORBIDITIES AMONG PATIENTS COMPARED IN BOTH GROUPS

Comorbidity analysis was performed to assess the distribution of pre-existing conditions between the stoma group and resection with anastomosis group. The most common comorbidities were hypertension (34%) and diabetes mellitus (26%), followed by cardiac disease (22%) and smoking (22%). Chronic obstructive pulmonary disease (COPD) was noted in 14% of patients.

Notably, 32% of patients in the stoma group and 28% in the resection group had no comorbidities, suggesting that both procedures were performed in patients with varying risk profiles. The distribution of comorbid conditions was similar across both groups, ensuring comparability.

Table 6 ENTEROCUTANEOUS FISTULA DEVELOPMENT IN BOTH GROUPS

The timing of fistula formation is a critical factor in postoperative outcomes. Early fistula formation (<7 days) was exclusively observed in the resection group, indicating the heightened vulnerability of anastomotic sites to leakage and inflammation during the early postoperative period. Late fistula formation (>7 days) occurred in both groups but remained more prevalent in the resection cohort.

Table 7 Distribution according to patient outcome

The recovery rate in both groups highlights the effectiveness of the respective procedures. Despite the higher complexity associated with resection and anastomosis, the recovery rates were comparable (72% for resection vs. 76% for stoma), indicating robust patient management strategies. The slightly lower mortality rate in the stoma group (12% vs. 14% in resection) aligns with the procedural safety observed in high-risk patients.

The calculated p-value for the outcome distribution between the Resection & Anastomosis group and the Stoma group is 0.747.

This suggests that there is no statistically significant difference in patient outcomes between the two groups. ​

Table 8 Duration of surgery and occurrence of complications

Prolonged surgical durations were associated with significantly higher rates of complications and mortality in both groups. Extended operative times (>2.5 hours) increased exposure to anesthesia and the risk of infection, particularly in resection cases.

The p-value for the distribution of surgery duration between the resection & anastomosis group and the stoma group is 1.0, indicating no significant difference between the groups. ​

Demographic and Clinical Characteristics

The study population included 50 patients, with 50% undergoing stoma placement and 50% undergoing resection with anastomosis. The average age, gender distribution, and comorbidities were similar across both groups, ensuring comparability.

Surgical Outcomes

• Stoma Placement: Patients who underwent stoma placement had a lower incidence of anastomotic leakage and shorter initial hospital stays. However, they required subsequent surgeries for stoma closure, leading to a longer overall treatment period.
• Resection and Anastomosis: This group showed a higher rate of early postoperative complications, including anastomotic leakage and infection. However, patients who recovered without complications benefited from restored bowel continuity and avoided the need for a second surgery.

Postoperative Complications

• Anastomotic Leakage: Occurred in 16% of patients undergoing resection and anastomosis, compared to 0 % in the stoma group.
• Infection Rates: Higher in the resection and anastomosis group (32%) compared to the stoma group (8%).
• Mortality: Overall mortality was comparable between the two groups but was notably higher in
• patients who developed anastomotic leakage.

TABLE 9 Comparison of Mean Age across Studies

In this study, the majority of cases fall within the 51-60 years age group, aligning with findings from Green et al. and Brown et al.

Smith et al. reported a slightly younger peak in the 40-50 years group, possibly due to differences in study populations or inclusion criteria.

These findings suggest that patients undergoing stoma or resection procedures are predominantly middle-aged to elderly.

Patient demographics, particularly age, align closely with other studies, indicating generalizability.

Table 10 Postoperative Complications

The findings in this study align closely with prior research, demonstrating that stoma placement consistently results in lower infection rates compared to resection and anastomosis. Green et al. [6] also highlighted this trend, particularly in patients with pre-existing risk factors for infection. These outcomes underscore the clinical implications of selecting stoma placement for high-risk patients to minimize postoperative morbidity. Furthermore, Thompson et al. [5] corroborated these findings, suggesting that infection rates can be a decisive factor in procedural selection, particularly in emergency settings. These observations reinforce the strategic value of stoma placement in mitigating complications and improving patient outcomes.

Table 11 Mortality Rates

Mortality rates were comparable between the two groups, reinforcing the safety of both approaches when selected appropriately based on patient stability and intraoperative findings. This consistency suggests that both procedures can be safely implemented, provided the patient selection is based on clinical indicators [5][6].

Table 12 Enterocutaneous Fistula

This study contributes to understanding the timing of fistula formation, with early fistulas observed more frequently in the resection group. The higher incidence of early fistulas in resection cases highlights the need for vigilant postoperative monitoring in this group [4]. Late fistulas were more common but less problematic.

Table 13 Duration of Surgery

Prolonged surgical durations were associated with increased complications and mortality rates. The data suggest that minimizing operative time is crucial to improving outcomes, especially in complex cases [6][10]. This trend highlights the importance of efficient surgical practices and careful patient selection to minimize risks.

1. This study provides valuable insights into patient outcomes following stoma and resection procedures.
2. Resection group is associated with maximum complications including anastomotic leakage and anastomotic leakages .enterocutaneous fistula is more commonly observed in resection group and recovery rates were better with stoma group.
3. Quality of life is better with resection group with keen post operative care and not associated with complications as second surgery and stoma care are avoided in this group.
4. While mortality and recovery rates show trends similar to those reported in previous studies, the findings highlight the importance of individualized surgical decision-making based on patient comorbidities and clinical status.

However, given the relatively small sample size, these results should be interpreted with caution. A larger, multicenter study is necessary to draw more definitive conclusions and enhance the accuracy of outcome comparisons between these surgical approaches.

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