Systematic review of intraoperative colonic irrigation vs. manual decompression in obstructed left-sided colorectal emergencies.
OBJECTIVE
A systematic review was conducted to determine if manual decompression is a safe alternative to intraoperative colonic irrigation prior to primary anastomosis in obstructed left-sided colorectal emergencies.


METHODS
Search for relevant articles from 1980 to 2007 was conducted on Medline, Embase and the Cochrane Controlled Trials Register using the keywords "colonic lavage, irrigation, decompression, washout, obstructed and bowel preparation", either singularly or in combination. Trials in English publications with similar patient characteristics, inclusion criteria and outcome measures were selected for analysis. Thirty-day mortality, anastomotic leak rates and post-operative wound infection were studied as outcome variables. Analysis was performed with RevMan 4.2 software.


RESULTS
Seven trials were identified for systematic review, with a total of 449 patients. Data from the single randomised controlled trial and one prospective comparative trial were analysed separately. Results from the remaining five studies were pooled into two arms of a composite series, one with colonic irrigation and one without. Results showed no significant difference in the anastomotic leak rates and mortality rates between the colonic irrigation and manual decompression arms in the randomised and comparative trials. The composite series, however, showed significantly better results with manual decompression (RR 6.18, 95% CI 1.67-22.86). The post-operative infection rate was similar in both groups.


CONCLUSIONS
Manual decompression was comparable to colonic irrigation for primary anastomosis in obstructed left-sided colorectal emergencies, with no significant increase in mortality, leak or infection rates.
Department of Colorectal Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
M H
MH
Kam
C L
CL
Tang
E
E
Chan
J F
JF
Lim
K W
KW
Eu
D000714:Anastomosis, Surgical / Q000379:methods* / Q000401:mortality; D002986:Clinical Trials as Topic; D003106:Colon / Q000601:surgery; D019299:Decompression, Surgical / Q000379:methods; D013505:Digestive System Surgical Procedures / Q000379:methods; D004630:Emergencies; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery*; D007430:Intraoperative Care / Q000379:methods*; D012007:Rectum / Q000601:surgery; D007507:Therapeutic Irrigation