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Role of resection and primary anastomosis of the left colon in the presence of peritonitis.
Br J Surg. 2000 Nov; 87(11):1580-4.BJ

Abstract

BACKGROUND

Classically a primary colonic anastomosis is not performed in the presence of left colonic peritonitis. Recently there has been a trend towards resection and anastomosis in selected patients, but no prospective study concerning the safety of this approach has been published. The objective of this study was to define the role of intraoperative colonic lavage with resection and primary anastomosis (RPA) in left colonic peritonitis, and to evaluate the differences in outcome in patients with diffuse or localized peritonitis.

METHODS

Between January 1994 and December 1998, 127 patients underwent emergency operation for a distal large bowel perforation. RPA was the operation of choice and was performed in 61 patients, 38 with localized and 23 with diffuse peritonitis. Septic shock, faecal peritonitis, immunocompromised status and American society of Anesthesiologists grade IV were contraindications to the one-stage procedure. Alternative operations used in high-risk patients were Hartmann's procedure in 55 patients, subtotal colectomy in eight and colostomy in three.

RESULTS

There were two deaths (3 per cent) among 61 patients treated by RPA and one (2 per cent) case of clinical anastomotic dehiscence. Overall morbidity was 39 per cent and the overall mean(s.d.) hospital stay was 18(15) days. No statistical differences were observed between patients with localized and diffuse peritonitis treated by RPA.

CONCLUSION

RPA may be the operation of choice in selected patients with left colonic diffuse peritonitis.

Authors+Show Affiliations

Department of Surgery, Ciudad Sanitaria y Universitaria de Bellvitge, University of Barcelona, Spain.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11091249

Citation

Biondo, S, et al. "Role of Resection and Primary Anastomosis of the Left Colon in the Presence of Peritonitis." The British Journal of Surgery, vol. 87, no. 11, 2000, pp. 1580-4.
Biondo S, Jaurrieta E, Martí Ragué J, et al. Role of resection and primary anastomosis of the left colon in the presence of peritonitis. Br J Surg. 2000;87(11):1580-4.
Biondo, S., Jaurrieta, E., Martí Ragué, J., Ramos, E., Deiros, M., Moreno, P., & Farran, L. (2000). Role of resection and primary anastomosis of the left colon in the presence of peritonitis. The British Journal of Surgery, 87(11), 1580-4.
Biondo S, et al. Role of Resection and Primary Anastomosis of the Left Colon in the Presence of Peritonitis. Br J Surg. 2000;87(11):1580-4. PubMed PMID: 11091249.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Role of resection and primary anastomosis of the left colon in the presence of peritonitis. AU - Biondo,S, AU - Jaurrieta,E, AU - Martí Ragué,J, AU - Ramos,E, AU - Deiros,M, AU - Moreno,P, AU - Farran,L, PY - 2000/11/25/pubmed PY - 2001/2/28/medline PY - 2000/11/25/entrez SP - 1580 EP - 4 JF - The British journal of surgery JO - Br J Surg VL - 87 IS - 11 N2 - BACKGROUND: Classically a primary colonic anastomosis is not performed in the presence of left colonic peritonitis. Recently there has been a trend towards resection and anastomosis in selected patients, but no prospective study concerning the safety of this approach has been published. The objective of this study was to define the role of intraoperative colonic lavage with resection and primary anastomosis (RPA) in left colonic peritonitis, and to evaluate the differences in outcome in patients with diffuse or localized peritonitis. METHODS: Between January 1994 and December 1998, 127 patients underwent emergency operation for a distal large bowel perforation. RPA was the operation of choice and was performed in 61 patients, 38 with localized and 23 with diffuse peritonitis. Septic shock, faecal peritonitis, immunocompromised status and American society of Anesthesiologists grade IV were contraindications to the one-stage procedure. Alternative operations used in high-risk patients were Hartmann's procedure in 55 patients, subtotal colectomy in eight and colostomy in three. RESULTS: There were two deaths (3 per cent) among 61 patients treated by RPA and one (2 per cent) case of clinical anastomotic dehiscence. Overall morbidity was 39 per cent and the overall mean(s.d.) hospital stay was 18(15) days. No statistical differences were observed between patients with localized and diffuse peritonitis treated by RPA. CONCLUSION: RPA may be the operation of choice in selected patients with left colonic diffuse peritonitis. SN - 0007-1323 UR - https://www.unboundmedicine.com/medline/citation/11091249/Role_of_resection_and_primary_anastomosis_of_the_left_colon_in_the_presence_of_peritonitis_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0007-1323&date=2000&volume=87&issue=11&spage=1580 DB - PRIME DP - Unbound Medicine ER -