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. |
