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


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.


RESULTS
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.


CONCLUSIONS
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.
Patriti
A
A
General and Emergency Surgery, Department of Surgery, University of Perugia, Perugia, Italy. albertopatriti@aliceposta.it
Contine
A
A
Carbone
E
E
Gullà
N
N
Donini
A
A
D000714:Anastomosis, Surgical / Q000009:adverse effects; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D003106:Colon / Q000601:surgery*; D004630:Emergencies; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery; D007416:Intestinal Perforation / Q000601:surgery; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017792:Surgical Stapling; D013529:Surgical Wound Dehiscence / Q000209:etiology*; D007507:Therapeutic Irrigation; D016896:Treatment Outcome