SUBTOTAL COLECTOMY VS. INTRAOPERATIVE COLONIC IRRIGATION IN THE MANAGEMENT OF OBSTRUCTED LEFT COLON-CARCINOMA

PURPOSE: Whether primary anastomosis should be performed after segment al resection with intraoperative colonic irrigation or subtotal colect omy is not vet established in the surgical treatment of obstructive le ft colon carcinoma. In this prospective, nonrandomized study, we prese nt the results of 66 patients undergoing one-stage surgery for obstruc ted left colon carcinoma. PATIENTS AND METHODS: We compared two techni ques, subtotal colectomy (35 patients) and intraoperative colonic irri gation with segmental resection and immediate anastomosis (31 patients ). RESULTS: The mortality rate was similar in both groups, 8.5 percent in the subtotal colectomy group and 3.2 percent in the intraoperative colonic irrigation group. The surgical complication rate was signific antly higher in the intraoperative colonic irrigation group (41.9 perc ent) than in the subtotal colectomy group (14.2 percent; P < 0.05). Me an operating time was significantly lower in the subtotal colectomy gr oup than in the intraoperative colonic irrigation group (P < 0.05). Bo th groups had a similar mean duration of hospital stay. Ten patients w ho underwent subtotal colectomy (31.2 percent) presented with diarrhea in the immediate postoperative period, which disappeared spontaneousl y or with antidiarrheal medication; a disabling diarrhea persisted in two patients only (6.2 percent). CONCLUSION: We belies-e that subtotal colectomy is the treatment of choice for obstructed left-sided coloni c carcinoma. Segmental resection with intraoperative colonic irrigatio n is more appropriate: than subtotal colectomy only in patients with c arcinomas of the rectosigmoid junction or with previous anal incontine nce to avoid the appearance of postoperative diarrhea.