Laparoscopic appendicectomy is a safe, predictable, easily learnt operation and an ideal model for learning the skills and principles required for more advanced laparoscopic colorectal interventions and in particular, right hemicolectomy.

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.

A simple method is described for decompressing the colon at laparotomy for large bowel obstruction.