Prospective study of primary anastomosis without colonic lavage for patients with an obstructed left colon

Author:

Naraynsingh V1,Rampaul R1,Maharaj D1,Kuruvilla T1,Ramcharan K1,Pouchet B1

Affiliation:

1. Department of Surgery, University of the West Indies, General Hospital, Port-of-Spain, Trinidad, West Indies

Abstract

Abstract Background Traditionally, left-sided colon obstruction is managed by a multistaged defunctioning colostomy and resection. However, there is growing acceptance of one-stage primary resection and anastomosis with on-table antegrade irrigation. This paper presents a series of patients managed prospectively by primary anastomosis without intraoperative colonic lavage. Methods Emergency resection of acutely obstructed left-sided colonic carcinomas was performed. This was followed by primary anastomosis without on-table lavage after bowel decompression using a new technique. Results Fifty-eight consecutive, unselected patients underwent bowel decompression, resection and primary colocolic anastomosis. Only one patient developed a leak at the anastomotic site, requiring pelvic abscess drainage and transverse loop colostomy. One death occurred 12 h following surgery. Autopsy confirmed that this was due to myocardial infarction. Mean hospital stay was 9·8 days. Conclusion Emergency surgery on the obstructed left colon can be carried out safely after decompression alone, without intraoperative colonic lavage.

Publisher

Oxford University Press (OUP)

Subject

Surgery

Reference13 articles.

1. Intraoperative irrigation of the colon to permit primary anastomosis;Dudley;Br J Surg,1980

2. Intraoperative colonic lavage and primary anastomosis in nonelective colon resection;Murray;Dis Colon Rectum,1991

3. Primary resection and anastomosis in obstructed descending colon due to cancer;Tan;Arch Surg,1991

4. Should primary anastomosis and on-table colonic lavage be standard treatment for left colon emergencies?;Allen-Mersh;Ann R Coll Surg Engl,1993

5. Peroperative lavage of the obstructed left colon to allow safe primary anastomosis;Pollock;Dis Colon Rectum,1987

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