Intraoperative colonic irrigation in the management of left sided large bowel emergecies in Jos University Teaching Hospital, Nigeria

Abstract

Objectives: To evaluate the safety and benefits of antegrade intraoperative colonic irrigation (lavage) and primary anastomosis, after colonic resection, in the treatment of left sided large bowel emergencies. Design: A prospective descriptive study. Setting: Jos University Teaching Hospital, Jos, Nigeria. Participants: Thirty seven patients with an average age of 44.86 ± 16.15 years. Intervention: Sigmoid colectomy was performed in twenty two sigmoid volvulus, five sigmoid cancer, two faecal fistulae and one sigmoid injury. Left hemicolectomy was offered in four descending colon cancer, one descending colon injury, while anterior resection was carried out in two rectal cancers. Primary anastomosis was performed after intraoperative colonic lavage. Results: The operative mortality was 2.7%, anastomotic leakage rate 2.7% and superficial wound infection occurred in 10.81%. The average duration of hospital stay was 22.76 ± 11.26 days. Intraoperative colonic lavage added 35.79 ± 7.25 minutes to the operating time. Conclusion:The results of this study suggest that intraoperative colonic lavage is an effective method enabling the surgeon to perform a primary anastomosis with reasonable safety after emergency resection of selected distal colonic lesions.

An Algorithm for the Management of Sigmoid Colon Volvulus and the Safety of Primary Resection: Experience with 827 Cases

“…3,4 In treating SCV, emergency operation is needed in cases of unsuccessful nonoperative treatment and when bowel gangrene or peritonitis is present. [1][2][3][4][5][6][7][8][17][18][19][20][21][22][23] We generally prefer a standard midline incision, as do some other surgeons, 8 which allows for all therapeutic procedures, such as detorsion, pexy, resection, anastomosis, or stomas. The basic principles of surgery are releasing the torsion, ascertaining the procedure to be performed (the first priority is to save life and the second is to obviate the possibility of recurrence), and treating complications if they arise.…”

“…Operative cleansing may be added to perform the primary anastomosis with reasonable safety. 3,21 Otherwise, Hartmann_s or Mikulicz procedures with resection may be lifesaving in gangrenous or unstable patients. However, they carry the mortality and morbidity risks of stomas and require a second operation.…”

Colorectal cancer in Nigeria: 40 years on. A review

“…The only report in which some patients (12%) had low stapled anastomosis of rectal carcinoma came from Lagos where a few patients could afford to procure the instruments (Adesanya 2006). The patients who presented with intestinal obstruction had emergency resections with end‐to‐end anastomosis (as one‐stage procedures) in some institutions (Sule et al . 2000) while others had preliminary colostomies (Akute 2000).…”

Resection and primary anastomosis with or without modified blow-hole colostomy for sigmoid volvulus

“…A number of studies on sigmoid volvulus explored the feasibility of one-stage resection using on-table lavage [13,[21][22][23][24] . The advantages of this approach include single stage procedure, no need for a colostomy, possible lower morbidity and mortality, and shorter hospital stay.…”

“…Traditionally, obstruction of the left colon is managed by a multi-stage defunctioning colostomy and resection. However, there is a growing acceptance of one-stage primary resection and anastomosis with the use of on-table antegrade irrigation [24,[26][27][28] . However, several studies have suggested that on-table lavage may not be necessary for a safe emergency RPA of unprepared left colon [26][27][28][29] .…”