U. Kressner et al., INTRAOPERATIVE COLONIC LAVAGE AND PRIMARY ANASTOMOSIS - AN ALTERNATIVE TO HARTMANN PROCEDURE IN EMERGENCY-SURGERY OF THE LEFT COLON, The European journal of surgery, 160(5), 1994, pp. 287-292
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.