One‐Stage Colectomy with Intraoperative Colonic Irrigation for Acute Left‐Sided Malignant Colonic Obstruction

Otsuka, Shimpei; Kikuchi, Yuji; Maeda, Atsuyuki; Takayama, Yoshiaki; Fukami, Yasuyuki; Isogai, Masatoshi

doi:10.1007/s00268-015-3078-5

Cited by 11 publications

(10 citation statements)

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“…The rate of wound infection of the primary anastomosis with intraoperative colonic irrigation is generally reported at 4%–37% [613]. In our study, the wound infection rate was 18.4% without any significant difference between patients with obstruction and those with peritonitis.…”

Section: Discussionmentioning

confidence: 40%

“…Since the early 1980s, several studies have supported the feasibility of a one-stage resection and primary anastomosis for patients with unprepared or inadequately prepared bowels who require a resection of a left colon lesion [51617], especially patients with obstruction [618] and peritonitis [1920]. The purpose of intraoperative colonic irrigation is to perform a safe anastomosis and decrease the anastomotic leakage rate by reducing the amount of feces around the anastomosis and decompressing the colon [1521].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, they emphasized that on-table colonoscopy prevented the risk of anastomotic leakage in 2 patients with a necrotic change of the proximal colonic mucosa. However, Otsuka et al [6] raised a question about the necessity of on-table total colonoscopy because recent advances in radiologic technology and postoperative total colonoscopy may be able to detect synchronous polyps. In our study, on-table colonoscopy was not performed, although we did use a double-lumen device (NICI) for intraoperative colonic irrigation.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with colon obstruction or peritonitis, however, undergoing preoperative mechanical bowel preparation is not possible. In this situation, general agreement exists that a right hemicolectomy with primary anastomosis can be safely performed for right colon resection [56]. On the other hand, when it comes to the left colon, several options are available.…”

Section: Introductionmentioning

confidence: 99%

“…A 1-stage colectomy with intraoperative colonic irrigation may be another option for treatment in cases where mechanical bowel preparation is not appropriate preoperatively. It is widely accepted as a safe procedure for treatment of left colon obstruction [6]. The purpose of irrigation is to achieve a colon free of feces that allows a decrease in the rate of suture failure and its attendant complications [12].…”

Section: Introductionmentioning

confidence: 99%

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The Usefulness of Intraoperative Colonic Irrigation and Primary Anastomosis in Patients Requiring a Left Colon Resection

2017

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PurposeThe aim of this study is to assess the short-term outcome of intraoperative colonic irrigation and primary anastomosis and to suggest the usefulness of the procedure when a preoperative mechanical bowel preparation is inappropriate.MethodsThis retrospective study included 38 consecutive patients (19 male patients) who underwent intraoperative colonic irrigation and primary anastomosis for left colon disease between January 2010 and December 2016. The medical records of the patients were reviewed to evaluate the patients' characteristics, operative data, and postoperative short-term outcomes.ResultsTwenty-nine patients had colorectal cancer, 7 patients had perforated diverticulitis, and the remaining 2 patients included 1 with sigmoid volvulus and 1 with a perforated colon due to focal colonic ischemia. A diverting loop ileostomy was created in 4 patients who underwent a low anterior resection. Complications occurred in 15 patients (39.5%), and the majority was superficial surgical site infections (18.4%). Anastomotic leakage occurred in one patient (2.6%) who underwent an anterior resection due sigmoid colon cancer with obstruction. No significant difference in overall postoperative complications and superficial surgical site infections between patients with obstruction and those with peritonitis were noted. No mortality occurred during the first 30 postoperative days. The median hospital stay after surgery was 15 days (range, 8–39 days).ConclusionIntraoperative colonic irrigation and primary anastomosis seem safe and feasible in selected patients. This procedure may reduce the burden of colostomy in patients requiring a left colon resection with an inappropriate preoperative mechanical bowel preparation.

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Section: Discussionmentioning

confidence: 40%