The Role Of An Isolated Anastomosis In One Stage Surgery In Acute Left Sided Colonic Obstruction
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There is a general agreement that primary resection and end-to-end anastomosis can and should be performed in most patients with perforative and obstructive lesions in the ascending and proximal transverse colon. A similar consensus is lacking with respect to identical conditions present in that segment of the large bowel distal to the transverse colon. In this study we present the technique of isolated colonic anastomosis as one stage surgery in acute left sided colonic obstruction and in high risk colo-colonic or colo-rectal anastomosis without creation of colostomy. It included 16 patients, 12 (75%) males and 4 (25%) females with the age range between (27-68 years) and a mean of (54.3 9.7 years). The abdomen was explored through a mid-line incision and resection of the colonic lesion was done on the standard fashion according to the indication. After mechanical cleansing of a proximal colonic segment, the lumen of the proximal colon is everted and an ordinary condom tube is sutured to the mucosa of the proximal segment, 3-5 cm proximal to the anastomotic line. The tube is then spreaded up and posterior layer of the anatomosis is done after which the tube is spreaded down the distal colonic segment, whenever the anterior layer of the anastomosis is completed. When the anastomosis is done low in the rectum the tube is drawn through the anus to lie outside. The operative technique included 11 cases of left hemicolectomy, of whom 9 cases were carcinomas of the left colon, and 2 cases of peritonitis secondary to perforated diverticulitis. In 3 cases, sigmoid colectomy for volvulus, and anterior resection for 2 cases of rectal carcinomas. The mean time length for fixation of the by-pass tube was (11.06l. 95) minutes. The mean length of whole surgical procedures was (13 0.917.6) minutes, the intestinal motility returned after a mean of (42.0+13.7) hours. The tube separated and passed spontaneously in all except in 2 patients after a mean period of (14.25 8.6) days. In the other 2 patients the tube could not be identified after a period of 32 days follow up. Pulmonary complication occurred in 2 patients (12.5%), anastomotic leakage occurred in another 2 patients (12.5%), one of them re-explored and the other one was managed conservatively. Superficial wound infection developed in 4 patients (25%). No operative or post-operative mortality and no anastomotic stenosis developed in our patients. To conclude, the technique of one stage isolated left colonic anastomosis can be a substitute for staged colonic resection in acute conditions of the left colon and in high risk anastomosis.