Colectomy and immediate anastomosis versus on-table colonic lavage for the management of acutely obstructed left colon

Abstract

Mohamed I Kassem, Hany M Elhaddad

Objective: The purpose of this work was to compare primary resection and immediate reconstruction after either manual decompression only or on-table lavage in the management of acutely obstructed left colonic lesions. Methods: This prospective study was conducted on 281 adult patients presenting to the Emergency Surgical Department of the Main Alexandria University Hospital, Faculty of Medicine, Alexandria University, Egypt, during the period from February 2011 to March 2016. Patients were randomly divided pre-operatively into two groups: group A, in which on-table colonic lavage was performed prior to anastomosis and group B, where immediate anastomosis was carried out after manual decompression. Results: Both groups were similar with regards to demographic data and etiology of obstruction. Group B had shorter operation times, less respiratory complications, reduced need for intensive care admission, decreased wound infection and shorter hospital stays. No statistically significant difference was found between benign and malignant causes. The rate of anastomotic leak did not vary between either group. Conclusions: In favorable situations, omission of on-table lavage may be preferred for immediate anastomosis in obstructed left colonic emergencies. The technique is reliable and well-tolerated with no additional morbidity or mortality.