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Intraoperative colonic lavage and primary anastomosis--an alternative to Hartmann procedure in emergency surgery of the left colon.

OBJECTIVE
To assess whether intraoperative lavage and primary resection with anastomosis is a safe alternative to a Hartmann procedure in emergency surgery of the left colon.


DESIGN
Retrospective study.


SETTING
University hospital.


MATERIAL
101 consecutive patients (39 emergency and 62 elective) who underwent a left-sided colonic resection during a 3-year-period.


INTERVENTIONS
17 of the emergency procedures comprised an intraoperative lavage followed by resection and primary anastomosis without faecal diversion; 17 were Hartmann procedures and 5 patients had primary resection without lavage.


MAIN OUTCOME MEASURES
Postoperative mortality, morbidity and duration of hospital stay in these two groups compared with these after a contemporary series of elective resections.


RESULTS
There were no postoperative deaths and no clinical anastomotic leaks in the lavage group. The duration of hospital stay (median 11 days) was similar in both groups (overall and sigmoid resection respectively). In the Hartmann group, there were two deaths and the postoperative stay in hospital was significantly longer.


CONCLUSIONS
Primary resection with intraoperative lavage can be done successfully in patients with acute obstruction of the left colon and the duration of hospital stay and morbidity are similar to those seen in patients operated on electively.