Is colonic lavage a suitable alternative for left-sided colonic emergencies?

The use of intra-operative colonic lavage (IOCL) with primary anastomosis remains controversial in the emergency left-sided large bowel pathologies, with alternatives including Hartmann's procedure, manual decompression and subtotal colectomy. To compare the peri-operative outcomes of IOCL to o...

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Published inWorld journal of gastrointestinal surgery Vol. 13; no. 4; pp. 379 - 391
Main Authors Tham, Hui Yu, Lim, Wen Hui, Jain, Sneha Rajiv, Mg, Cheng Han, Lin, Snow Yunni, Xiao, Jie Ling, Foo, Fung Joon, Wong, Kar Yong, Chong, Choon Seng
Format Journal Article
LanguageEnglish
Published United States Baishideng Publishing Group Inc 27.04.2021
Subjects
Systematic Reviews
Intra-operative colonic lavage
Colon
Colonic neoplasm
Emergency surgery
Colonic irrigation
Anastomosis
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Summary:The use of intra-operative colonic lavage (IOCL) with primary anastomosis remains controversial in the emergency left-sided large bowel pathologies, with alternatives including Hartmann's procedure, manual decompression and subtotal colectomy. To compare the peri-operative outcomes of IOCL to other procedures. Electronic databases were searched for articles employing IOCL from inception till July 13, 2020. Odds ratio and weighted mean differences (WMD) were estimated for dichotomous and continuous outcomes respectively. Single-arm meta-analysis was conducted using DerSimonian and Laird random effects. Of 28 studies were included in this meta-analysis, involving 1142 undergoing IOCL, and 634 other interventions. IOCL leads to comparable rates of wound infection when compared to Hartmann's procedure, and anastomotic leak and wound infection when compared to manual decompression. There was a decreased length of hospital stay (WMD = -7.750; 95%CI: -13.504 to -1.996; = 0.008) compared to manual decompression and an increased operating time. Single-arm meta-analysis found that overall mortality rates with IOCL was 4% (CI: 0.03-0.05). Rates of anastomotic leak and wound infection were 3% (CI: 0.02-0.04) and 12% (CI: 0.09-0.16) respectively. IOCL leads to similar rates of post-operative complications compared to other procedures. More extensive studies are needed to assess the outcomes of IOCL for emergency left-sided colonic surgeries.
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Corresponding author: Choon Seng Chong, FRCS (Ed), MBBS, Assistant Professor, Division of Colorectal Surgery, University Surgical Cluster, National University Health System, 1E Kent Ridge Road, Singapore 119228, Singapore. choon_seng_chong@nuhs.edu.sg
Author contributions: Study conception and design was conducted by Jain SR, Mg CH and Chong CS; material preparation, data collection, analysis and interpretation were performed by Tham HY, Lim WH, Jain SR, Mg CH and Lin SY; the first draft was written by Tham HY, Lim WH, Jain SR and Mg CH; all authors commented on previous versions of the manuscript, read and approved the final manuscript.
ISSN:1948-9366
1948-9366
DOI:10.4240/wjgs.v13.i4.379