A simplified operative technique for single-staged resection of left-sided colon obstructions: report of a 9-year experience.
OBJECTIVE
The operative strategy for left-sided large bowel obstruction remains controversial. Because a safe and definitive single-staged operation that avoided a colostomy would clearly be in the patients' best interest, we conducted a prospective study to compare the efficacy of single-staged surgery (SSS) supplemented by the milking and swabbing technique (MST), with the conventional Hartmann's procedure (HP).


METHODS
In group 1 ( n = 37) we performed traditional HP by resecting the site of obstruction and constructing an end colostomy. In group 2 ( n = 33), after resecting the site of obstruction, instead of on-table lavage, we cleaned out the fecal content from the proximal and distal parts of the obstruction by milking the colon with the fingers, then swabbing the proximal and distal 10 cm of lumen of the colonic anastomosis with povidone iodinized stick sponges. Finally, we performed a primary one-layer anastomosis without fecal diversion.


RESULTS
The mortality, morbidity, and postoperative hospital stay after emergency left-side colonic resection and primary anastomosis by MST was comparable with those after HP ( P > 0.05).


CONCLUSIONS
We believe that SSS with MST is a viable choice in the surgical management of selected patients with obstructing lesions of the left colon. The advantages of SSS with MST lie in its good long-term results, and short-term reduced surgical intervention and hospital stay.
Turan
Mustafa
M
Department of General Surgery, Cumhuriyet University Faculty of Medicine, 58140 Sivas, Turkey.
Ok
Engin
E
Sen
Metin
M
Koyuncu
Ayhan
A
Aydin
Cengiz
C
Erdem
Mustafa
M
Güven
Yakup
Y
D000208:Acute Disease; D000368:Aged; D000714:Anastomosis, Surgical; D003108:Colonic Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D007507:Therapeutic Irrigation; D016896:Treatment Outcome