title: Current practices in left-sided colonic emergencies: a survey of US gastrointestinal surgeons.
abstract: BACKGROUND
  The paradigms in the surgical management of obstruction and perforation of the left colon - once considered absolute contraindications to primary resection and anastomosis - are changing. The aim of this survey was to poll American Gastrointestinal surgeons on their current approach to left colonic emergencies.
  
  
  METHODS
  A questionnaire was sent to 500 US-based surgeons, randomly selected members from the membership list of the Society for Surgery of the Alimentary Tract. It surveyed the surgeons on how they would approach 'good-risk' and 'poor-risk' patients with left colonic obstruction or perforation.
  
  
  RESULTS
  215 (43%) surgeons responded to the questionnaire; 180 fully completed questionnaires (36%) were analyzed. Sigmoid obstruction: 96 responders (53%) selected a one-stage procedure in 'good-risk' patients; 78 preferred sigmoid resection with (n = 46) or without (n = 32) 'on-table' colonic lavage and 18 opted for a subtotal colectomy and ileo-rectal anastomosis. Most (94%) responders preferred a staged procedure in 'high-risk' patients: a Hartmann resection (n = 120) or a transverse colostomy (n = 46). Sigmoid diverticular perforation: only one third of the responders recommended a one-stage procedure in 'good-risk' patients: 58 would perform a sigmoidectomy with (n = 19) or without (n = 39) 'on-table' colonic lavage; only two opted for subtotal colectomy with ileo-rectal anastomosis. In 'high-risk' patients most surgeons opted for a Hartmann's (88%) procedure or a diverting colostomy (7%).
  
  
  CONCLUSIONS
  This survey suggests that a half and one-third of the responders would perform a one-stage resection and anastomosis in 'good-risk' patients with left colonic obstruction and perforation, respectively. In 'poor-risk' patients most responders would still opt for a staged procedure.
authors.affiliation: Department of Surgery, New York Methodist Hospital, Brooklyn, NY, USA.
authors.forename: A
authors.initials: A
authors.lastname: Goyal
authors.forename: M
authors.initials: M
authors.lastname: Schein
mesh_terms: D000714:Anastomosis, Surgical; D003108:Colonic Diseases / Q000601:surgery*; D004241:Diverticulum, Colon / Q000601:surgery; D004630:Emergencies; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States