Management of obstructing carcinoma of the left colon by extended right hemicolectomy

Extended right hemicolectomy and left hemicolectomy for colorectal cancers between the distal transverse and proximal descending colon

“…7 ERH for the treatment of left-sided colonic tumours was first reported in 1985 and showed significant technical advantages over left colectomies or transverse segmental resections at the expense of longer segments of bowel resected. 8 Technically, it utilises a highly mobile segment of the bowel, the ileum, to transpose it towards the left colon and perform the ileocolonic anastomosis without tension. 8,9 ERH has also been conducted laparoscopically, 7,10 and in both elective and emergency settings.…”

Management of left-sided colonic obstruction by subtotal colectomy and ileocolic anastomosis

“…Saline is flushed through a tube in the caecum or ileum and drained together with colonic contents through a tube inserted proximal to the obstructing tumour (antegrade lavage) (16,17). Another method is 'surgical bowel preparation' in which the distended proximal colon is removed (subtotal colectomy), and with it all gross faecal residue (1,9,10,13,17,18). The distal colon never poses a problem as it is well decompressed with minimal if any stool distal to the obstruction.…”

“…Immediate resection and anastomosis after decompression and cleansing of the obstructed colon has a low complication rate and is therefore a safe alternative to staged procedures (1,4,9,10,13,15,(17)(18)(19)(20).…”

The Management of Malignant Large Bowel Obstruction: ACPGBI Position Statement

“…Subtotal colectomy was first reported in obstructing cancer by Klatt et al. in 1981 [117] and other studies have revealed mortality rates of between 0% and 11%, anastomotic leak rates between 0% and 10% and wound infections in 3–26% of patients [95–102]. Most mention functional results and many patients have increased bowel frequency often requiring constipating agents in the initial weeks after surgery.…”

“…These reports give an indication of the safety of the procedure but because there is still some selection bias the details of patients included and excluded are crucial to their interpretation. Subtotal colectomy was first reported in obstructing cancer by Klatt et al in 1981 [117] and other studies have revealed mortality rates of between 0% and 11%, anastomotic leak rates between 0% and 10% and wound infections in 3-26% of patients [95][96][97][98][99][100][101][102]. Most mention functional results and many patients have increased bowel frequency often requiring constipating agents in the initial weeks after surgery.…”