Prospective study of primary anastomosis without colonic lavage for patients with an obstructed left colon

Background: Traditionally, left-sided colon obstruction is managed by a mul tistaged defunctioning colostomy and resection. However, there is growing a cceptance of one-stage primary resection and anastomosis with on-table ante grade irrigation. This paper presents a series of patients managed prospect ively by primary anastomosis without intraoperative colonic lavage. Methods: Emergency resection of acutely obstructed left-sided colonic carci nomas was performed. This was followed by primary anastomosis without on-ta ble lavage after bowel decompression using a new technique. Results: Fifty-eight consecutive, unselected patients underwent bowel decom pression, resection and primary colocolic anastomosis. Only one patient dev eloped a leak at the anastomotic site, requiring pelvic abscess drainage an d transverse loop colostomy. One death occurred 12 h following surgery. Aut opsy confirmed that this was due to myocardial infarction. Mean hospital st ay was 9.8 days. Conclusion: Emergency surgery on the obstructed left colon can be carried o ut safely after decompression alone, without intraoperative colonic lavage.