Should primary anastomosis and on-table colonic lavage be standard treatment for left colon emergencies?
All patients with left colon obstruction or infection admitted under the care of one surgical firm over a 2.5-year period underwent on-table colonic lavage and primary anastomosis. Results were compared with all other similar patients treated during the same period in the same health district (involving a stoma in all cases). No significant difference in perioperative mortality or morbidity between primary anastomosis and Hartmann's groups was demonstrated. Hartmann's procedure necessitated a stoma for over 2 months with an 11% incidence of stoma-related complications. The stoma was not reversed in 25% of cases. Total inpatient stay was an average of 14 days shorter (95% CI 4.7-22.7 days) for primary anastomosis compared with Hartmann's patients. On-table lavage with primary anastomosis should be standard treatment for left colon emergencies.
Allen-Mersh
T G
TG
Department of Surgery, Westminster Hospital, London.
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D003106:Colon / Q000601:surgery*; D003110:Colonic Neoplasms / Q000601:surgery; D003125:Colostomy; D004239:Diverticulitis, Colonic / Q000601:surgery; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012086:Reoperation; D007507:Therapeutic Irrigation; D013997:Time Factors