[Left colectomy with immediate anastomosis in emergency surgery].Ann Chir. 1999; 53(10):1023-8.AC
PURPOSE OF THE STUDY
A retrospective study of our experience with one-stage left colectomy for acute diverticulitis and obstruction with a review of the literature to more clearly define the indications of this procedure.
PATIENTS AND METHODS
30 patients were operated for acute diverticulitis (group 1) and 47 for obstruction (group 2). Only 7 patients (23%) of group 1 had an intraoperative colonic lavage while this was performed for all the patients of group 2.
The postoperative morbidity and mortality for the patients of group 1 and 2 were 37 and 28%, and 7 and 11% respectively. None of the patients of group 1 had clinical anastomotic leak, while this occurred in 2 patients (4%) of group 2. The mean hospital stay was 26 days for patients of group 1 and 17 days for patients of group 2.
Bowel obstruction should be treated by one-stage left colectomy and intraoperative 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 diverticulitis and a localized abscess or peritonitis should be treated with one-stage colectomy; an immediate protected anastomosis could be performed in patients with generalized purulent peritonitis while a Hartmann's type colectomy should be the reasonable option for fecal generalized peritonitis. Intraoperative colonic lavage does not seem mandatory.