Total colectomy: Options in management of acute obstruction of the left-side colon

Abstract

Total colectomy with anastomosis is a suitable procedure for treating left-sided colonic obstruction provided that pelvic floor is adequate. Total colectomy has low mortality, acceptable morbidity and good quality of life. The success of the surgery depends on the selection of patients.

Is Total-subtotal Colectomy and Primary Anastomosis Good Treatment Alternatives in Malignant Obstructive Lesions of the Left Colon?

“…[26,27] Reported complication rates associated with this technique in several series are from 2-8% for anastomosis leakage, 10-21% for morbidity, and 0-10% for mortality, which are all lower than with multi-step procedure alternatives. [26,29,30] As a result, as concluded in this study, total/subtotal colectomy can be a good alternative with low morbidity and mortality rates in selected patients when performed by experienced surgeons. [26,28] Another treatment method that is used in malignant colonic obstructions is placement of a self-expandable stent inside the tumor to enable passage.…”

Medial to lateral lymph nodes dissection for primary radical resection of colon cancer, complicated by large bowel obstruction

“…Сторонники тотальных/субтотальных резекций толстой кишки утверждают, что такой тип операции позволяет избежать проблем «неподготовленного» кишечника и снизить риск несостоятельности анастомоза путем наложения илеосигмо-или илеоректоанастомоза, а также является мерой профилактики метахронных опухолей в правой половине ободочной кишки, которые достигают 11 % [11]. Послеоперационная летальность при данном методе лечения ОТКН составляет 6,0-9,7 %, различные осложнения, трудно поддающиеся коррекции, -15-21 %, в том числе несостоятельность анастомоза (5 %) [11,12] и развитие стойкой диареи (18-33 %) [12,13].…”

Outcome of emergency one-stage resection and anastomosis procedure for patients with obstructed colorectal cancer

“…Because of the fear of the suture failure at the time of the emergent one-stage resection and anastomosis, recently elective one-stage resection and anastomosis has increased after intestinal decompression by the construction of artificial anus (7)(8)(9)(10)(11), and trans-anal tube and stent (1)(2)(3)(4)12). However, until the operation the QOL of the patients was affected because of the difficulty in managing the daily frequency of stools.…”