Indications and Outcomes of Colon Resection in a Conflict Zone: A Single-Center Experience from a Military Hospital in Yemen

Purpose: Although colon resection is a common procedure, data regarding its indications and outcomes in conflict-affected regions are limited. These environments present unique surgical challenges, driven by the dual burden of acute trauma and advanced-stage chronic diseases. This study aimed to analyze the experience of colon resection at a military hospital in Yemen to identify key risk factors and inform surgical practices in austere settings. Methods: A single-center prospective observational study was conducted on 89 patients who underwent colon resection at a military hospital in Sana'a, Yemen between September 2022 and April 2024. Data on patient demographics, indications, surgical procedures, and postoperative outcomes were collected and analyzed. The primary endpoint was the incidence of adverse outcomes, defined as a composite of significant morbidity and in-hospital mortality. Results: A total of 89 patients were included (mean age 36.9 years; 91.0% male). The predominant indication for surgery was penetrating trauma (78.7%). The procedure-specific anastomotic leak rate for the 55 patients who underwent primary anastomosis was 7.3%. The overall adverse outcome (AE) rate was 19.1%. The strongest predictor of adverse outcomes was hemodynamic instability on admission; patients presenting with shock had an adverse rate of 34.6% compared to 12.7% in stable patients, a trend that approached statistical significance (P = 0.066). No significant difference in outcomes was found between trauma and cancer diagnosis. Conclusion: In this conflict-zone hospital, the patient's initial physiological state was the most critical determinant of postoperative outcomes following colon resection. Despite the austere conditions, the observed anastomotic leak rate was comparable to international standards, suggesting that primary anastomosis is a viable option in carefully selected, hemodynamically stable patients. These findings underscore the need for context-specific guidelines that prioritize aggressive resuscitation and physiological risk stratification to guide surgical decision making. Trial Registration: Not applicable.