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[Perforated diverticular disease of the left colon. Proposed single-stage left colectomy protected by a three-way lavage and active aspiration tube (di Gullino) positioned inside or below the anastomosis. Experience in 65 cases].
Minerva Chir. 1998 Dec; 53(12):1059-67.MC

Abstract

BACKGROUND

The incidence of perforative diverticulitis of the left colon is steadily increasing. Today the decision is generally taken to perform two-stage surgery: segmentary resection without (Hartmann's operation) or with anastomosis, but protected by a colostomy ("limited intervention"). This study aimed to examine standard colectomy performed in a single operation ("ideal intervention").

METHODS

Left colectomy with primary ligature of the lower mesenteric artery and vein at the source and outlet, en bloc removal of the colon-mesocolon and immediate transverse colorectal anastomosis. Anastomosis protected by the omentum which is also used to peritonise the retroperitoneum and to wrap around the anastomosis, and anastomosis also protected by the author's three-way lavage and active aspiration tube in either a trans- or subanastomosis and transanal position. Urgency is essential for this single-stage operation, together with massive dose antibiotic treatment limited to the pre- and postoperative stages, but above all peritoneal cleansing using accurate, methodical, repeated and abundant lavage with 8-10-20 or more litres, but only used 500 ml at a time. Of these 65 cases, 40 (62%) were purulent localised peritonitis and 25 (38%) were generalised (14 purulent, 4 fecaloid and 7 fecal). 8 cases (12.3%) underwent surgery in three stages and 16 (24.6%) underwent sigmoidectomy in one or two stages ("limited intervention"), 41 cases (63%) (1985-95, when Gullino's three-way tube became available) underwent standard colectomy in a single stage.

RESULTS

Morbidity in 10 cases/65 (15%) and septic mortality in 5 cases/65 (7.7%) (limited to generalised peritonitis alone) only affected patients undergoing "limited interventions", but none of the 41 patients undergoing "ideal intervention". Mortality was significantly influenced by age: 50% of over 80 year-olds, none below 60. Postoperative hospitalisation was 17.1 days (in the first stage) of "limited interventions" and 9.7 days for "ideal interventions".

CONCLUSIONS

The results argue clearly in favour of the "courageous" ideal colectomy with peritoneal lavage and protection of the colorectal anastomosis using Gullino's three-way tube.

Authors+Show Affiliations

Divisione di Chirurgia Generale, USL n. 17, Regione Piemonte, Ospedale SS. Annunziata, Savigliano, Cuneo.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

English Abstract
Journal Article

Language

ita

PubMed ID

10210940

Citation

Gullino, D, et al. "[Perforated Diverticular Disease of the Left Colon. Proposed Single-stage Left Colectomy Protected By a Three-way Lavage and Active Aspiration Tube (di Gullino) Positioned Inside or Below the Anastomosis. Experience in 65 Cases]." Minerva Chirurgica, vol. 53, no. 12, 1998, pp. 1059-67.
Gullino D, Giordano O, Lijoi C, et al. [Perforated diverticular disease of the left colon. Proposed single-stage left colectomy protected by a three-way lavage and active aspiration tube (di Gullino) positioned inside or below the anastomosis. Experience in 65 cases]. Minerva Chir. 1998;53(12):1059-67.
Gullino, D., Giordano, O., Lijoi, C., Masella, M., & De Carlo, A. (1998). [Perforated diverticular disease of the left colon. Proposed single-stage left colectomy protected by a three-way lavage and active aspiration tube (di Gullino) positioned inside or below the anastomosis. Experience in 65 cases]. Minerva Chirurgica, 53(12), 1059-67.
Gullino D, et al. [Perforated Diverticular Disease of the Left Colon. Proposed Single-stage Left Colectomy Protected By a Three-way Lavage and Active Aspiration Tube (di Gullino) Positioned Inside or Below the Anastomosis. Experience in 65 Cases]. Minerva Chir. 1998;53(12):1059-67. PubMed PMID: 10210940.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Perforated diverticular disease of the left colon. Proposed single-stage left colectomy protected by a three-way lavage and active aspiration tube (di Gullino) positioned inside or below the anastomosis. Experience in 65 cases]. AU - Gullino,D, AU - Giordano,O, AU - Lijoi,C, AU - Masella,M, AU - De Carlo,A, PY - 1999/4/22/pubmed PY - 1999/4/22/medline PY - 1999/4/22/entrez SP - 1059 EP - 67 JF - Minerva chirurgica JO - Minerva Chir VL - 53 IS - 12 N2 - BACKGROUND: The incidence of perforative diverticulitis of the left colon is steadily increasing. Today the decision is generally taken to perform two-stage surgery: segmentary resection without (Hartmann's operation) or with anastomosis, but protected by a colostomy ("limited intervention"). This study aimed to examine standard colectomy performed in a single operation ("ideal intervention"). METHODS: Left colectomy with primary ligature of the lower mesenteric artery and vein at the source and outlet, en bloc removal of the colon-mesocolon and immediate transverse colorectal anastomosis. Anastomosis protected by the omentum which is also used to peritonise the retroperitoneum and to wrap around the anastomosis, and anastomosis also protected by the author's three-way lavage and active aspiration tube in either a trans- or subanastomosis and transanal position. Urgency is essential for this single-stage operation, together with massive dose antibiotic treatment limited to the pre- and postoperative stages, but above all peritoneal cleansing using accurate, methodical, repeated and abundant lavage with 8-10-20 or more litres, but only used 500 ml at a time. Of these 65 cases, 40 (62%) were purulent localised peritonitis and 25 (38%) were generalised (14 purulent, 4 fecaloid and 7 fecal). 8 cases (12.3%) underwent surgery in three stages and 16 (24.6%) underwent sigmoidectomy in one or two stages ("limited intervention"), 41 cases (63%) (1985-95, when Gullino's three-way tube became available) underwent standard colectomy in a single stage. RESULTS: Morbidity in 10 cases/65 (15%) and septic mortality in 5 cases/65 (7.7%) (limited to generalised peritonitis alone) only affected patients undergoing "limited interventions", but none of the 41 patients undergoing "ideal intervention". Mortality was significantly influenced by age: 50% of over 80 year-olds, none below 60. Postoperative hospitalisation was 17.1 days (in the first stage) of "limited interventions" and 9.7 days for "ideal interventions". CONCLUSIONS: The results argue clearly in favour of the "courageous" ideal colectomy with peritoneal lavage and protection of the colorectal anastomosis using Gullino's three-way tube. SN - 0026-4733 UR - https://www.unboundmedicine.com/medline/citation/10210940/[Perforated_diverticular_disease_of_the_left_colon__Proposed_single_stage_left_colectomy_protected_by_a_three_way_lavage_and_active_aspiration_tube__di_Gullino__positioned_inside_or_below_the_anastomosis__Experience_in_65_cases]_ L2 - http://www.diseaseinfosearch.org/result/2310 DB - PRIME DP - Unbound Medicine ER -