Left colectomy with immediate anastomosis in emergency surgery.

Purpose of the study: a retrospective study of our experience with one-stag e left colectomy for acute diverticulitis and obstruction with a review of the literature to more clearly define the indications of this procedure. Pa tients and methods: 30 patients were operated for acute diverticulitis (gro up 1) and 47 for obstruction (group 2). Only 7 patients (23%) of group 1 ha d an intraoperative colonic lavage while this was performed for all the pat ients of group 2. Results: the postoperative morbidity and mortality for th e patients of group 1 and 2 were 37 and 28 %, and 7 and 11% respectively. N one of the patients of group 1 had clinical anastomotic leak, while this oc curred in 2 patients (4%) of group 2. The mean hospital stay was 26 days fo r patients of group 1 and 17 days for patients of group 2. Conclusions: bow el obstruction should be treated by one-stage left colectomy and intraopera tive colonic lavage for patients with low anaesthetic risks (ASA 1 and 2). Immediate anastomosis protected by colostomy or ileostomy could be proposed for patients with an intermediate risk (ASA 3). Patients with acute divert iculitis and a localized abscess or peritonitis should be treated with one- stage colectomy; an immediate protected anastomosis could be performed in p atients with generalized purulent peritonitis while a Hartmann's type colec tomy should be the reasonable option for fecal generalized peritonitis. Int raoperative colonic lavage does not seem mandatory.