On-table colonic irrigation in the treatment of left-sided large-bowel emergencies

Abstract

In a series of 27 patients who required surgery for distal colonic lesions, primary bowel resection with immediate anastomosis after intraoperative antegrade colonic irrigation was performed. The technique of on-table lavage was similar to that described by Dudley and Radcliffe in 1980; however, some new technical details are introduced to minimize fecal contamination. There were 17 men and 10 women (mean age, 68.5 years). Twenty patients were admitted for obstructing carcinoma of the left colon; 11 underwent immediate surgery, while the remaining 9 underwent delayed surgery after 12 hours of intravenous fluids and nasogastric suction. Of the remaining seven patients, five had perforated sigmoid diverticula and diffuse peritonitis and two had obstructing diverticular disease of the left colon with remarkable bowel distention. One hospital mortality occurred secondary to a ruptured aortic aneurysm. The radiologic anastomotic leakage rate was 14.8 percent. Clinical anastomotic dehiscence was not observed.

Detection and treatment of synchronous lesions in colorectal cancer: The clinical implication of perioperative colonoscopy

“…The traditional treatment is a two-stage Hartmann procedure [15] . Single stage procedures have also been tried with reports of positive results in most cases [11,[16][17] . A subtotal colectomy and the standard bowel resection, after an on-table bowel preparation with antegrade colonic irrigation, are the two most popular procedures.…”

Complete single-stage management of left colon cancer obstruction with a new device

“…A single-stage procedure for OLCC has been tried over the past 20 years with favorable results [10,[12][13][14]26]. Although some surgeons have reported favorable results from one-stage surgery for OLCC without bowel cleansing [21,30].…”

“…Long term, it has the disadvantage of increasing the possibility of frequent bowel movements and incontinence [13,26]. The advantage of IACI over subtotal colectomy is that it prevents frequent bowel movements and incontinence [26].…”

“…Although not widely accepted, single-stage procedures have been tried by many institutions over the past 20 years with reports of positive results in most cases [10,[12][13][14]. Subtotal colectomy with ileocolic or ileorectal anastomosis and on-table bowel preparation with intraoperative antegrade clonic irrigation (IACI) and primary anastomosis are the two most described procedures.…”

An uncomplicated and safe way to perform on-table colonic lavage

“…Their method, a modification of the method described by Muir in 1968 [2], increased the chances of performing a safe colocolic anastomosis in patients with acute or sub-acute left-colonic obstruction. Since then, the details of the procedure have been unchanged, although slight modifications [3,4] as well as more extensive alterations [5] have been proposed. On-table lavage after the anastomosis is constructed has also been described [6].…”