ONE-STAGE RESECTION AND ANASTOMOSIS FOR ACUTE OBSTRUCTION OF THE LEFTCOLON

PURPOSE: The purpose of this study tvas to analyze a single surgeon's experience with one-stage resection with primary anastomosis in acute obstruction of the left colon, emphasizing intraoperative decompressio n before the anastomosis. METHOD: From January 1986 to September 1996, 91 patients received one-stage resection with primary anastomosis for acute obstruction of the left colon. Eighty-five of these 91 patients were operated on for carcinoma of the colon and rectum. Subtotal cole ctomies were performed in 20 patients, left hemicolectomies in 21 pati ents, sigmoid colectomies in 34 patients, and anterior resections in 1 6 patients. The preoperative serum albumin level nas less than 3 gm/dl in 17 patients (less than 2.5 gm/dl in 10 patients). Four patients ha d associated abscesses, and one patient had colonic perforation with p eritonitis before operative colonoscopy. Neither antegrade nor retrogr ade irrigation was performed. RESULTS: Operative mortality rate was 2. 2 percent. There were two cases (2.2 percent) of anastomotic leakages. Other common complications included wound infection (11 cases), urina ry tract infection (5 cases), intestinal obstruction (6 cases), and re spiratory failure (3 cases). CONCLUSION: This experience suggests that an anastomosis can be performed mote safely in patients with acute ob struction of the left colon than in those with an anastomosis in the n ondiverted colon. Neither intraoperative irrigation nor routine subtot al colectomy was found to be necessary. Anastomosis below the peritone al reflection is also not a contraindiction.