On-table colonic irrigation in the treatment of left-sided large-bowel emergencies

Is colonic lavage a suitable alternative for left-sided colonic emergencies?

BACKGROUND

The use of intra-operative colonic lavage (IOCL) with primary anastomosis remains controversial in the emergency left-sided large bowel pathologies, with alternatives including Hartmann’s procedure, manual decompression and subtotal colectomy.

AIM

To compare the peri-operative outcomes of IOCL to other procedures.

METHODS

Electronic databases were searched for articles employing IOCL from inception till July 13, 2020. Odds ratio and weighted mean differences (WMD) were estimated for dichotomous and continuous outcomes respectively. Single-arm meta-analysis was conducted using DerSimonian and Laird random effects.

RESULTS

Of 28 studies were included in this meta-analysis, involving 1142 undergoing IOCL, and 634 other interventions. IOCL leads to comparable rates of wound infection when compared to Hartmann’s procedure, and anastomotic leak and wound infection when compared to manual decompression. There was a decreased length of hospital stay (WMD = -7.750; 95%CI: -13.504 to -1.996; P = 0.008) compared to manual decompression and an increased operating time. Single-arm meta-analysis found that overall mortality rates with IOCL was 4% (CI: 0.03-0.05). Rates of anastomotic leak and wound infection were 3% (CI: 0.02-0.04) and 12% (CI: 0.09-0.16) respectively.

CONCLUSION

IOCL leads to similar rates of post-operative complications compared to other procedures. More extensive studies are needed to assess the outcomes of IOCL for emergency left-sided colonic surgeries.

Detection and treatment of synchronous lesions in colorectal cancer: The clinical implication of perioperative colonoscopy

AIM: To evaluate the clinical significance of pre- and intra-operative colonoscopy for the detection of synchronous lesions in colon cancer.

METHODS: Two hundred and sixty-five pre-operative and 51 intra-operative colonoscopic evaluations were performed in 316 colorectal cancer patients who underwent curative resection from January 2001 to June 2006. The incidence and characteristics of synchronous lesions and their influence on surgery were evaluated.

RESULTS: Two hundred and eighty-two synchronous lesions were detected in 124 (39.2%) of 316 patients including all lesions regardless of their histologic type. True adenomatous polyps were found in 91 (28.8%) of 316 patients, and 17 (5.4% of all patients) patients had synchronous colon cancers. The preoperative identification of synchronous lesions altered the planned surgery in 37 (14.0%) of 265 patients. In 18 patients among the surgically removed cases, the lesions were removed by extending the resection range. Further segmental resection or polypectomy through enterotomy was necessary in 19 patients. Nineteen (37.2%) of 51 intraoperative colonoscopy cases had synchronous lesions. Additional surgical procedures including segmental bowel resection and polypectomy with enterotomy were necessary in 7 (13.7%) of 51 intraoperative colonoscopy cases to remove the lesions.

CONCLUSION: Synchronous colorectal polyps or cancer are frequent and their preoperative detection is important for optimal surgical planning and treatment. Intraoperative colonoscopy is a useful option in cases where a preoperative colonoscopy is not feasible.

Complete single-stage management of left colon cancer obstruction with a new device

BACKGROUND

A newly developed device that enables easy intraoperative colonic irrigation and subsequent colonoscopy was introduced recently.

METHODS

To evaluate the efficacy of the single-stage procedure with a new device and the significance of on-table colonoscopy, 112 patients with obstructive left colon cancer were recruited.

RESULTS

Primary anastomosis after tumor resection was performed in 104 cases. The volume of saline used for irrigation averaged 13.5 l over 12.1 min. Subsequent colonoscopic examination added an average of 10.4 min to the operative time. There were three anastomotic leaks, two wound infections, four acute renal failures, and two operative mortalities. On-table colonoscopy resulted in extended resection in 17 cases.

CONCLUSIONS

The new device enabled safe, simple, and time-saving, single-stage surgical management of left colon cancer obstruction. The ability to perform on-table colonoscopy enabled treatment and recognition of synchronous bowel pathology.

Comparison between segmental left and extended right colectomies for obstructing left-sided colonic carcinomas

PURPOSE

This study was designed to compare complications and functions following either radical extended right colectomy without colonic decompression or radical segmental left colectomy with intraoperative decompression for obstructed left-sided colonic carcinomas.

METHODS

One hundred three patients with obstructed left-sided colonic carcinoma undergoing primary resection and anastomoses were studied.

RESULTS

There were 57 males and 46 females with a median age of 65 (range, 24-98) years and who had a median follow-up of 31 (range, 2-59) months. There were no leaks or intra-abdominal sepsis in the extended right colectomy group (44 patients) compared with one anastomosis leak in the segmental left colectomy (59 patients) group. Median hospital stay was 14 days in both groups, with a range of 8 to 36 days in the segmental left colectomy group and 7 to 44 days in those with extended right resection. One month after surgery, the patients who underwent segmental left colectomy had a median bowel movement of 3 (range, 1-6) per 24 hours compared with those with extended right colectomies who had a median of 5 (2-11) bowel movements per 24 hours. Bowel frequency decreased to four or less episodes per 24 hours in all patients in both groups at six months.

CONCLUSION

There was no significant difference between bowel function or complications between the two groups.