Single stage primary anastomosis without colonic lavage for left-sided colonic obstruction due to acute sigmoid volvulus: a prospective study of one hundred and ninety-seven cases

De, Utpal; Ghosh, Saswata

doi:10.1046/j.1445-2197.2003.t01-2-02654.x

Cited by 53 publications

(46 citation statements)

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“…De et al [26] reported 197 patients who had a single stage primary anastomosis without colonic lavage for leftsided colonic obstruction due to acute sigmoid volvulus; only 2 (1.01%) patients developed symptomatic anastomotic leak. In a similar prospective study by Raveenthiran [29] , 57 consecutive patients with acute sigmoid volvulus had emergency RPA without ontable lavage or caecostomy.…”

Section: Discussionmentioning

confidence: 99%

“…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] .…”

Section: Discussionmentioning

confidence: 99%

“…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] . Most experts agree that temporary proximal fecal diversion or decompression can reduce the risk of sepsis resulting from anastomotic leakage [30,31] .…”

Section: Discussionmentioning

confidence: 99%

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

Çoban¹,

Yılmaz²,

Terzi³

et al. 2008

WJG

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Çoban¹,

Yılmaz²,

Terzi³

et al. 2008

WJG

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“…Leakage of anastomosis is caused by many factors [27,28]. Anastomoses made in urgent cases of trauma [29], cancer with obstruction [30], diverticulum of the colon [16,31], twisting [32] and peritonitis [33] have also shown that absolute cleanness of bowel before forming anastomosis is not necessary. The wall of inflated intestine after the removal of occlusion remains resilient enough, and anastomosis is mechanically hermetic.…”

Section: Discussionmentioning

confidence: 99%

One-Stage Operation for Cancer of the Left Colon with Bowel Obstruction: Do We Need On-Table Wash-Out of the Colon?

et al. 2006

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Background: Cancer of the left colon with obstruction (CLCO) is a serious disease. Many surgeons perform one-stage resection with the on-table wash-out of the colon. However, there is uncertainty concerning the necessity of wash-out and absolute clearness of the colon. Our goal was to clarify that. Patients and Methods: The data of 108 patients urgently operated due to CLCO from 1996 to 2005 were analyzed retrospectively and prospectively. Results: On-table wash-out was performed in 59 patients, and 49 patients were without it. Both groups were similar by age, gender, tumor site, and extent of operation. The rate of complications in the first and the second group was 30.5 and 28.6%, respectively. Suture leakage was observed in 8.5% of patients in the first group and 4.1% in the second group (total 6.5%). Most frequently, leakage was observed in cases of resection of the rectum (18.9%) (p = 0.04). The type of suture did not have any significant impact on the occurrence of leakages (p > 0.05). Intraoperative wash-out prolonged the duration of operation by 33.2 min (p < 0.001). The postoperative mortality rate in the first and the second group was 3.39% and 6.1%, respectively; (total 4.64%). Only 1 patient died due to the complications caused by suture leakage. Conclusion: One-stage surgery due to CLCO is safe, and intraoperative wash-out is not necessary.

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“…Sigmoid volvulus has been treated successfully by resection and primary anastomosis without colonic lavage. 7 We have approached our left-sided obstructed patients in a similar manner arguing that, provided mobilisation and blood supply are good, a side-to-side stapled colorectal anastomosis will deal with any size disparity in the bowel and allow a rapid decompression of the system. Our experience is presented.…”

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confidence: 99%

Primary Anastomosis Without Colonic Lavage for the Obstructed Left Colon

Cross

Rees

Soulsby

et al. 2008

annals

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Ann R Coll Surg Engl 2008; 90: 302-304 302Obstructing left-sided colonic lesions are associated with a high mortality and morbidity. [1][2][3][4] When emergency surgery is undertaken at night or performed by a registrar or noncolorectal specialist, two-staged Hartmann resections are frequently performed. Whilst this approach provides quick, safe surgery with relatively low complication rates, restoration of bowel continuity is only performed in a proportion and is frequently challenging. Emergency segmental resection with on-table lavage (OTL) and primary anastomosis has been championed since 1967. 5 There are no good randomised trials comparing primary anastomosis versus Hartmann resections and a subsequent reversal with its additional morbidity. Elective, left-sided resection/anastomosis without mechanical bowel preparation has recently been shown not only to be a safe surgical option but also to be associated with reduced morbidity. 6 OTL can be time-consuming, messy and requires a proximal enterotomy and considerable bowel handling, all of which potentially increase morbidity. Sigmoid volvulus has been treated successfully by resection and primary anastomosis without colonic lavage. 7 We have approached our left-sided obstructed patients in a similar manner arguing that, provided mobilisation and blood supply are good, a side-to-side stapled colorectal anastomosis will deal with any size disparity in the bowel and allow a rapid decompression of the system. Our experience is presented. Patients and MethodsWe have undertaken a prospective, observational study of 24 consecutive emergency admissions presenting between November 1996 and November 2004 with left-sided colonic obstruction. Obstruction was confirmed by pre-operative gastrograffin enema. All anaesthetised patients were placed OTL is time-consuming, requires considerable mobilisation/bowel handling, an enterotomy and potentially exposes the patient to mesenteric vascular injury, faecal contamination and a prolonged ileus. We have assessed outcome following primary resection and anastomosis without prior lavage.

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Single stage primary anastomosis without colonic lavage for left-sided colonic obstruction due to acute sigmoid volvulus: a prospective study of one hundred and ninety-seven cases

Abstract: Primary colonic anastomosis can be safely done for obstructed left colon due to acute sigmoid volvulus without intraoperative colonic lavage.

Cited by 53 publications

References 0 publications

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

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

One-Stage Operation for Cancer of the Left Colon with Bowel Obstruction: Do We Need On-Table Wash-Out of the Colon?

Primary Anastomosis Without Colonic Lavage for the Obstructed Left Colon

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