IngentaConnect Primary anastomosis without colonic lavage for the obstructed lef...

Authors: Cross, K.L.R.¹; Rees, J.R.¹; Soulsby, R.H.R.¹; Dixon, A.R.¹

Source: Annals of The Royal College of Surgeons of England, Volume 90, Number 4, May 2008 , pp. 302-304(3)

Publisher: The Royal College of Surgeons of England

Abstract:

INTRODUCTION: Resection, on-table lavage (OTL) and primary anastomosis is the treatment of choice for the obstructed left colon. OTL is time-consuming, requires considerable mobilisation/bowel handling, an enterotomy and potentially exposes the patient to mesenteric vascular injury, faecal contamination and a prolonged ileus. We have assessed outcome following primary resection and anastomosis without prior lavage.

PATIENTS AND METHODS: Twenty-four consecutive, obstructed patients underwent splenic flexure mobilisation and high anterior resection (concomitant small bowel resection in 2) with primary side-to-side colorectal anastomosis without either prior lavage or covering stoma. Outcome was audited.

RESULTS: Twenty-four patients, 17 female aged 48-92 years (median. 76 years) presented with left-sided obstruction due to carcinoma (Dukes' B [3], C [6], D [1]) or chronic diverticulitis (14). Median operative time was 85 min (range, 40-105 min). Colonic ileus resolved on day 2 (29%) and day 3 (58%). Median hospital stay was 7 days (range, 6-72 days); 92% discharged by day 10. There were no deaths or re-admissions. A return to theatre followed a reactionary haemorrhage in one. This latter patient's anastomosis leaked on day 4 (no faecal contamination) and was converted to an end stoma. Urinary and wound infections were seen in two. Late complications comprised two anastomotic strictures; both responded to balloon dilatation at 5 months.

CONCLUSIONS: Resection and primary anastomosis without on-table lavage is an easy, practical, predictable and safe treatment option for left-sided colonic obstruction with minimal complications.

Keywords: OBSTRUCTED COLON; PRIMARY ANASTOMOSIS; ON-TABLE LAVAGE

Document Type: Research article

DOI: 10.1308/003588408X285874

Affiliations: 1: Department of Colorectal Surgery, North Bristol NHS Trust, Frenchay Hospital, Bristol, UK

Primary anastomosis without colonic lavage for the obstructed left colon