STAGED RESECTION OR PRIMARY ANASTOMOSIS FOR OBSTRUCTING LESIONS TO THE LEFT COLON

The management of obstructing left-sided colonic and rectal lesions ha s traditionally been by a staged procedure, The introduction of 'on-ta ble lavage', has made primary resection and anastomosis of the large b owel feasible for patients presenting as emergencies, We have studied the perioperative course of 28 patients who presented with left coloni c obstruction to determine whether primary anastomosis conferred addit ional morbidity, The patients ranged in age from 29 to 89 years (mean 66 years) at presentation, The ASA status of patients was comparable i n both groups (Table 1), Fourteen patients underwent resection, on-tab le lavage, and primary anastomosis (PA) and 14 a Hartmann's procedure (HP). The mean operative time for the PA procedure was 200 minutes com pared to 110 minutes for the HP group, There was no significant differ ence in the postoperative complication rate nor mean hospital stay rat e for the primary procedures between the two groups, There was no clin ical anastomotic leak in patients undergoing primary anastomosis, Howe ver secondary surgery for patients undergoing colorectal reconnection conferred added morbidity for patients who had a HP, We conclude that resection, on-table lavage, and primary anastomosis is safe in the man agement of left-sided colonic obstruction and in most cases is the tre atment of choice.