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

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.

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

Document Type: Research article

DOI: http://dx.doi.org/10.1308/003588408X285874

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

Publication date: 2008-05-01

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• The Annals of The Royal College of Surgeons of England is the official journal of the College and is published eight times a year in January, March, April, May, July, September, October and November. The main aim of the journal is to publish high quality, peer-reviewed papers that relate to all branches of surgery.
  
  The Annals also includes letters and comments, a regular technical section, NICE news, controversial topics, CORESS feedback, book reviews and the best trainee presentations from England and Wales. The editorial board is composed of members of the College Council and experts from across the surgical specialties.
  
  Archive issues of the Annals of The Royal College of Surgeons of England are available via the PubMed Central database
  
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