INTRAOPERATIVE COLONIC LAVAGE AND PRIMARY ANASTOMOSIS - AN ALTERNATIVE TO HARTMANN PROCEDURE IN EMERGENCY-SURGERY OF THE LEFT COLON

Objective. To assess whether intraoperative lavage and primary resecti on with anastomosis is a safe alternative to a Hartmann procedure in e mergency surgery of the left colon. Design: Retrospective study. Setti ng: University hospital. Material: 101 consecutive patients (39 emerge ncy and 62 elective) who underwent a left-sided colonic resection duri ng a 3-year-period. Interventions: 17 of the emergency procedures comp rised an intraoperative lavage followed by resection and primary anast omosis without faecal diversion; 17 were Hartmann procedures and 5 pat ients had primary resection without lavage. Main outcome measures: Pos toperative mortality, morbidity and duration of hospital stay in these two groups compared with these after a contemporary series of electiv e resections. Results: There were no postoperative deaths and no clini cal anastomotic leaks in the lavage group. The duration of hospital st ay (median 11 days) was similar in both groups (overall and sigmoid re section respectively). In the Hartmann group, there were two deaths an d the postoperative stay in hospital was significantly longer. Conclus ions: Primary resection with intraoperative lavage can be done success fully in patients with acute obstruction of the left colon and the dur ation of hospital stay and morbidity are similar to those seen in pati ents operated on electively.