Abstract :
In patients with Critical conditions of intestinal gangrene, an exploratory laparotomy should be performed immediately. After removing the affected segment, the remaining portion would either be anastomosed or diverted as a stoma. few studies have investigated the psychosocial effects and the Global Quality of Life after the surgical treatment for intestinal vascular gangrene (anastomosis versus stoma) and the subsequent events. In this study, perioperative outcomes of psychosocial issues were evaluated in relation to the surgical treatment of mesenteric vascular gangrene patients. Two hundred patients subjected to emergency surgical laparotomy due to mesenteric vascular gangrene were randomly divided into two groups with one hundred patients of anastomosis group and the other group of one hundred patients who had a diverting stoma. A comparative evaluation was established between the two groups using the global quality of life as a primary endpoint of the study. There was a significant difference in the quality of life between the anastomotic group and the stoma group. The global quality of life of stoma patients significantly improved after closure, (p < 0.001). The ileostomy appeared to be a safer procedure to perform in mesenteric vascular occlusion as regard morbidity and mortality rates but need strict nutritional, psychological and special home care to enhance the quality of life. On other hand, there is a higher mortality risk for the anastomosis group, particularly after a leak, but experienced a better global quality of life with uncomplicated anastomosis. The critical decision for the surgeon after resection of infarcted bowel either to do stoma or anastomosis should consider the long- term impact on patient life quality and psychological status.
