The role of one-stage surgery in acute left-sided colonic obstruction

Published on Apr 1, 1995in American Journal of Surgery2.565
路 DOI :10.1016/S0002-9610(99)80185-8
Peter W. K. Lau8
Estimated H-index: 8
(HKU: University of Hong Kong),
Chung-Yau Lo73
Estimated H-index: 73
(HKU: University of Hong Kong),
Wai Lun Law52
Estimated H-index: 52
(HKU: University of Hong Kong)
Sources
Abstract
Background One-stage surgery with primary anastomosis is not widely accepted for acute leftsided colonic obstruction. Patients and Methods Forty-four patients representing our total admission for acute left-sided colonic obstruction over a 3-year period were evaluated with regard to their suitability for onestage surgery and primary anastomosis. Results Thirty-five patients (80%) were found to be suitable for this approach and the failures were mainly due to either the advanced nature of the malignant lesions or to their distal location, which precluded an anastomosis. The overall in-hospital mortality was 11%, but only 2 patients (6%) died in the one-stage surgery group, and these deaths were unrelated to anastomotic leakage. This latter complication occurred in 1 patient representing a leak rate of 3%. Conclusions
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#1John J. MurrayH-Index: 38
#2David J. SchoetzH-Index: 58
Last. Veidenheimer McH-Index: 7
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: In selected individuals requiring emergency colon resection, intraoperative colonic lavage with primary anastomosis represents a safe alternative to staged reconstruction. This procedure achieves excellent mechanical preparation of the colon, facilitates safe anastomosis, and avoids the disadvantages associated with multistaged operations. At our institution, 25 patients requiring urgent segmental resection of the left colon have undergone intraoperative colonic lavage. Primary anastomosis wit...
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#1Victor W. Fazio (Cleveland Clinic)H-Index: 135
#2James M. Church (Cleveland Clinic)H-Index: 98
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Current therapy in colon and rectal surgery , Current therapy in colon and rectal surgery , 讴鬲丕亘禺丕賳賴 丿蹖噩蹖鬲丕賱 噩賳丿蹖 卮丕倬賵乇 丕賴賵丕夭
#1A HalevyH-Index: 1
#2J LeviH-Index: 1
Last. R OrdaH-Index: 1
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During a 5-year period, 22 patients with obstructing carcinoma of the left colon were operated on in our department. All patients underwent emergency subtotal colectomy with primary ileocolonic or ileorectal anastomosis. The quality of life for patients undergoing subtotal colectomy is excellent. All patients enjoy an almost normal diet and those with an ileorectal anastomosis stabilize on two to three bowel movements per day. During a followup period of 65 months, four patients died from spread...
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: Obstructing carcinomas of the left colon are traditionally managed with a staged resection, as immediate colonic anastomosis is associated with a high risk of anastomotic dehiscence. We have prospectively performed total or subtotal colectomy in 18 consecutive patients presenting with obstruction at or distal to the splenic flexure. The operative mortality was 11%, which compared favourably with the results of other methods of surgical management. The procedure is safe and no cases of anastomo...
#1A. V. PollockH-Index: 20
#2M. J. PlayforthH-Index: 6
Last. Mary EvansH-Index: 17
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A series of 44 patients with complete or partial left-colon obstruction underwent laparotomy and intraoperative colonic lavage. Irrigation was unsuccessful in three, the operation being concluded by a Hartmann resection. In the remaining 41, the achievement of an empty colon allowed primary anastomosis after resection of the obstructing lesion. Seven patients (17.1 percent) died, none of dehiscence of the colorectal anastomosis, although minor anastomotic leaks occurred in four. The median posto...
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Last. D. J. Leaper (BRI: Bristol Royal Infirmary)H-Index: 4
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The management of acute distal colonic obstruction remains controversial. The advent of intraoperative colonic irrigation has allowed primary anastomosis to be performed in obstructed bowel. Fifteen patients, with acute distal obstruction due to carcinoma, diverticulitis or sigmoid volvulus were managed by primary resection and anastomosis. There were two leaks (14 percent) and the duration of operation was prolonged. In an experimental study of anastomotic healing after acute obstruction, intra...
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#1Wyn P. Morgan (Cardiff University)H-Index: 4
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Summary In obstructing carcinomas of the left colon, primary resection with immediate colocolonic anastomosis is associated with a high risk of anastomotic dehiscence, and therefore, it has become traditional to manage such patients with staged resection. In obstructing carcinomas of the right colon, immediate resection of the lesion with ileocolonic anastomosis is acceptable. The scope of right hemicolectomy can be extended to encompass obstructing carcinomas of the left colon by performing sub...
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: The technique described herein permits antegrade irrigation of the intestine peroperatively to empty the obstructed or loaded colon of feces. This procedure extends the indication for safe primary anastomosis of the colon during surgical treatment of the left colon, and our experience with 64 patients is described.
Fourteen cases of severe obstructing carcinoma of the left colon were treated by emergency subtotal colectomy and ileorectal or ileosigmoid anastomoses. There was one death after two months and a further two septic postoperative complications. Follow-up stretched from two to 39 months (an average 13.7 months). One patient died of a myocardial infarction after 11 months and another of liver metastases after 21 months. Two patients were lost to follow-up at 12 and 25 months, and nine patients rema...
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#2Lee E. SmithH-Index: 20
Last. Robert C. CochranH-Index: 4
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Abstract This retrospective review of seven patients with completely obstructing cancers of the left half of the colon, in addition to other reports in the literature, suggests that subtotal colectomy with primary ileal 1 Clinical data on seven patients who underwent subtotal colectomy for obstructing carcinoma of the left colon: 1975鈥1982PatientAge (yr) and SexTumor LocationHospital StayComments168, FDecending10 daysA and W 40 mo postop 1 271, FSigmoid22 daysA and W 18 mo postop373, FSigmoid鈥 ...
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#1Fia Yi (San Antonio Military Medical Center)H-Index: 3
For the readership of this text, performing the actual procedure to remove diseased, malignant tumors of the colon is straightforward. Adhering to the oncologic principle of clear margins with adequate lymph node harvest is paramount. In the acute setting of obstruction and bleeding, adhering to these principles can often be difficult because of the size of the tumor, tumor invasion into surrounding structures, and patient factors (hemodynamically unstable, poor nutritional status, etc.). This c...
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It is debatable whether laparoscopic surgery is suitable for obstructive colorectal cancer.We retrospectively reviewed the clinical and oncological effectiveness of laparoscopic surgery after tube decompression for obstructive colorectal cancer in 54 patients (18 laparoscopic resections, 36 open resections).There were no significant differences between groups with respect to mean size, location, depth, and stage of tumor, median operating times, or median number of lymph nodes retrieved. Abdomin...
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Purpose: The aim of this study was to assess the feasibility and safety of laparoscopic resection following the insertion of self-expanding metallic stents (SEMS) for the treatment of obstructing left-sided colon cancer. Methods: Between October 2006 and December 2012, laparoscopic resection following SEMS insertion was performed in 54 patients with obstructing left-sided colon cancer. Results: All 54 procedures were technically successful without the need for conversion to open surgery. The med...
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AIM: To evaluate surgical outcomes after stent insertion for obstructing colorectal malignancy and to compare between laparoscopic and open approach. METHODS: Surgical resection was performed after stent insertion for malignant colorectal obstruction in 36 patients with a median age of 73 years. Eighteen patients were treated with open resection, whereas 18 underwent a laparoscopic resection. The outcomes were evaluated and comparison was made between patients with laparoscopic and open resectio...
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Th is study aimed to describe a case in which an obstructing splenic fl exure carcinoma treated with segmental colectomy with primary anastomosis aft er decompression of the obstructed unprepared colon without intraoperative colonic lavage . A wide review of the literature was also performed. A 54 years old man was admitt ed to our hospital with abdominal pain, distension, repeated vomiting and absolute constipation. Patient investigated and underwent emergency laparotomy with a presumptive diag...
#1Kazuhito SasakiH-Index: 16
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BACKGROUND: Intraoperative colonic irrigation and intraoperative on-table colonoscopy may be useful for a more accurate diagnosis of colorectal cancer before colectomy in patients with obstructive left-sided colorectal cancer, but the clinical benefit of this technique has not been investigated in large-scale studies. OBJECTIVE: The aim of this study was to evaluate the usefulness of intraoperative colonic irrigation with a Y-shaped irrigation device and intraoperative colonoscopy in the managem...
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#1Ker-Kan Tan (TTSH: Tan Tock Seng Hospital)H-Index: 21
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Introduction Surgical treatment of obstructed colorectal cancers has been associated with significant perioperative morbidity and mortality. This study was performed to review the spectrum of surgery and early outcome of patients with acutely obstructed colorectal cancers. The secondary aims were to compare right- and left-sided obstruction and to identify factors predicting morbidity and mortality in these patients.
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