Intra-operative colonic irrigation in the management of left-sided large bowel emergencies

Koruth, N M; Krukowski, Z. H.; Youngson, George; Hendry, Wilson S.; Logie, John; Jones, Peter F.; Munro, A.

doi:10.1002/bjs.1800720911

Cited by 120 publications

(46 citation statements)

References 23 publications

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“…The results show that intraoperative bowel irrigation, which is often recommended in not well-prepared patients, is probably not as important as believed [21]. Previous reports also show that the complication rates are not increased when intraoperative bowel irrigation is not performed [22].…”

Section: Discussionsupporting

confidence: 51%

Complicated Diverticulitis of the Sigmoid: A Prospective Study Concerning Primary Resection with Secure Primary Anastomosis

et al. 1999

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Background: The Hartmann procedure remains the standard concerning the surgical treatment of acute complicated sigmoid diverticulitis. The aim of this study was to prove the possibility of performing a secure primary anastomosis without colostomy in patients with complicated acute diverticulitis. Methods: From June 1988 to October 1996, 113 patients suffering from acute complicated sigmoid diverticulitis were included in this prospective study. Within 24–48 h of hospital admission, when symptoms of the illness persisted despite the use of antibiotic therapy, the patients underwent primary resection of the sigmoid. In all patients primary anastomosis was performed, using CEEA staplers, avoiding colostomy and intraoperative colon irrigation. Results: During the observation period of 19 days, there was no anastomotic leakage found either by radiological methods or clinical parameters. Two patients died of early septic complications, 1 of therapy-resistant endocarditis. Conclusion: The results of this study demonstrate the safety of primary anastomosis after primary resection of the sigmoid under antibiotic conditions, avoiding the disadvantages associated with two-stage procedures.

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Section: Discussionsupporting

confidence: 51%

Complicated Diverticulitis of the Sigmoid: A Prospective Study Concerning Primary Resection with Secure Primary Anastomosis

et al. 1999

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“…There is a 4% risk of developing an anastomotic leak, which requires another operation to take down the anastomosis and create a temporary colostomy (19,20). After emergency resection, the patient remains in the intensive care unit (ICU) for two days and then another 12 days in the surgical ward (3,21,22).…”

Section: Competing Strategies Rsmentioning

confidence: 99%

The Cost-Effectiveness of Colonic Stenting as a Bridge to Curative Surgery in Patients with Acute Left-Sided Malignant Colonic Obstruction: A Canadian Perspective

Singh

Latosinsky

Spiegel

et al. 2006

Canadian Journal of Gastroenterology

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The cost-effectiveness of colonic stenting as a bridge to curative surgery in patients with acute left-sided malignant colonic obstruction: A Canadian perspective. Can J Gastroenterol 2006;20(12):779-785.BACKGROUND: Over the past several years, colonic stenting has been advocated as an alternative to the traditional surgical approach for relieving acute malignant left-sided colonic obstruction. The aim of the present study was to determine the most cost-effective strategy in a Canadian setting. PATIENTS AND METHODS: A decision analytical model was developed to compare three competing strategies: CS -emergent colonic stenting followed by elective resective surgery and reanastomosis; RS -emergent resective surgery followed by creation of either a diverting colostomy or primary reanastomosis; and DC -emergent diverting colostomy followed by elective resective surgery and reanastomosis. The costs were estimated from the perspective of the Manitoba provincial health plan. RESULTS: The use of CS resulted in fewer total operative procedures per patient (mean CS 1.03, RS 1.32, DC 1.9), lower mortality rate (CS 5%, RS 11%, DC 13%) and lower likelihood of requiring a permanent stoma (CS 7%, RS 14%, DC 14%). CS is slightly more expensive than DC, but less costly than RS (DC $11,851, CS $13,164, RS $13,820). The incremental cost-effectiveness ratio associated with the use of CS versus DC is $1,415 to prevent a temporary stoma, $1,516 to prevent an additional operation and $15,734 to prevent an additional death. CONCLUSIONS: Colonic stenting for patients with acute colonic obstruction secondary to a resectable colonic tumour is comparable in cost with surgical options, and reduces the likelihood of requiring both temporary and permanent stomas. Colonic stenting should be offered as the initial therapeutic modality for Canadian colorectal cancer patients presenting with acute obstruction as a bridge to definitive RS.

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“…Todavia, ela tem sido adotada também para as lesões do cólon esquerdo, com bons resultados 17,20 . Koruth et al 18 recomendam a realização de irrigação colônica intraoperatória, com redução significativa da morbimortalidade. Em cinco pacientes deste grupo a lesão estava localizada no cólon esquerdo.…”

Section: Discussionunclassified

Obstrução intestinal no idoso

Henry

Lerco

Oliveira

et al. 2007

ABCD, arq. bras. cir. dig.

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A população brasileira vem apresentando nas últimas cinco décadas mudanças nos níveis de mortalidade e fecundidade, as quais vêm caindo a uma velocidade nunca vista anteriormente 19 . Essa mudança de comportamento populacional -à qual dá-se o nome de transição demográfica 19,27 -é a responsável pelo envelhecimento da população.A medida que o número de pessoas que atingem idade avançada continua a crescer, existe necessidade associada de prover cuidados médicos eletivos e de emergência a um número cada vez maior de pacientes idosos 13 .Dentre as causas de internação hospitalar, a obstrução intestinal ocupa posição de destaque, sendo responsável por 3% das admissões 2,22 .Com relação ao atendimento do paciente idoso com obstrução intestinal, existem questões importantes que devem ser elucidadas, tais como distinção entre obstrução funcional ou mecânica, simples ou estrangulada e deter- brida (38%), câncer de colon (24%), hérnias (12%), impactacão fecal (12%), carcinomatose (10%) e volvo da sigmóide (4%). A mortalidade foi de 18% associada à complicações infecciosas em todos os pacientes. Conclusões -a) A distinção entre a obstrução intestinal funcional e orgânica oferece dificuldade no idoso; b) o câncer do colon constitui-se em importante causa de obstrução intestinal com quadro obstrutivo já na primeira manifestação clínica desse tumor; c) bridas e hérnias são igualmente importantes na etiologia da obstrução intestinal; d) os sinais clínicos obstrutivos são poucos evidentes no idoso e a leucometria é mais fidedigna para este diagnóstico. DESCRITORES -Obstrução intestinal, idoso, tratamento. ABCDDV/564

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Intra-operative colonic irrigation in the management of left-sided large bowel emergencies

Cited by 120 publications

References 23 publications

Complicated Diverticulitis of the Sigmoid: A Prospective Study Concerning Primary Resection with Secure Primary Anastomosis

Complicated Diverticulitis of the Sigmoid: A Prospective Study Concerning Primary Resection with Secure Primary Anastomosis

The Cost-Effectiveness of Colonic Stenting as a Bridge to Curative Surgery in Patients with Acute Left-Sided Malignant Colonic Obstruction: A Canadian Perspective

Obstrução intestinal no idoso

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