Gut resection and anastomosis: a five-year experience at the Moi teaching and referral hospital, Eldoret, Kenya

Abstract

Problem statement: The advances in the procedure of gut resection and anastomosis has undergone a series of transitions with varied levels of adoption in different hospital institutions. This has prompted a wide variation in experiences. Objective: To explore and share the surgical experiences with gut resection and anastomosis over a five-year period in Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. Design: Retrospective, hospital based study of patients who underwent resection and anastomosis in the hospital. Setting: The general surgical wards of Moi Teaching and Referral Hospital, a 750 bed tertiary teaching and referral hospital in the Western region of Kenya for the period 2002 – 2006 both years inclusive. Poplation: Two hundred and twenty patients of all ages who underwent gut resection and anastomosis for varied reasons over the period of study. Main outcome measures: The primary outcome measures were demographic data on gut resection and anastomosis, common reasons for it and the types of anastomosis done. The secondary outcome measures were morbidity and mortality following gut resection and anastomosis. Results: There was a male: female ratio of 2.5:1. The age ranged from 2 days to 94 years with a mean ± standard deviation of 34.2±23.4 years. Majority of the patients (34%) were in the age group 0- 20 years. Acute abdomen accounted for 95% of the causes leading to resection and anastomosis. Most of the patients presented within days of the onset of symptoms, leading to deranged vital signs in 65% of them. The delays in presentation and need for resuscitation led to delay in surgery with 35% of the patients getting operated on more than 24 hours after admission. Post -operative complications, duration of hospital stay and outcome of management were related to the types of anastomosis done. The morbidity and mortality rates were 22.7% and 15.9% respectively. Conclusions: The MTRH experience with gut resection and anastomosis compares favourably in morbidity and mortality with other institutions in the world.