One-stage resection without colonic lavage in emergency surgery of the left colon

• Published in: Colorectal disease Vol. 7; no. 4; pp. 332 - 338
• Main Authors: Patriti, A., Contine, A., Carbone, E., Gullà, N., Donini, A.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.07.2005
• Subjects: anastomosis; Anastomosis, Surgical - adverse effects; Colectomy - adverse effects; Colectomy - methods; Colon; Colon - surgery; colon resection; Emergencies; Female; Humans; Intestinal Obstruction - surgery; Intestinal Perforation - surgery; intra-operative colonic lavage; Intraoperative Period; Male; Middle Aged; obstruction; peritonitis; Retrospective Studies; Surgical Stapling; Surgical Wound Dehiscence - etiology; Therapeutic Irrigation; Treatment Outcome
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/j.1463-1318.2005.00812.x

Objective  Intra‐operative colonic lavage is a widespread procedure introduced to decompress and clean the colon of its faecal load during emergency surgery of the left colon in order to perform a safe anastomosis. This type of lavage is never performed at our institution. The aim of this study was to evaluate the safety and acceptability of emergency left‐sided colectomy without colonic lavage in a consecutive series of patients admitted at our department for perforation and obstruction of the left colon. Patients and methods  All 44 patients (29 with obstruction and 15 with perforation) on whom a one‐stage left‐sided colon resection was performed without colonic lavage between January 1998 and June 2004 were evaluated in a retrospective review. During this period all patients with acute disease of the left colon underwent a one stage resection without colonic lavage. The only exclusion criteria for anastomosis were: haemodynamic instability, ASA > 3, unresectable tumour. Death, anastomotic leakage and wound infection were main outcome measures. Result  The leak rate was 4.5% and mortality 2.3% due to one case of postoperative myocardial infarction. A 16% morbidity rate was recorded due to 4 wound infections and 3 minor complications. Conclusion  The procedure is safe. The low morbidity and mortality of one stage resection without colonic lavage can justify future prospective studies enrolling a large number of patients to compare its results with those obtained by one stage resection with colonic lavage.