There is a general agreement that primary resection and end-tpr^/nd;
Anastomosis can and should be performed in most patients with perforative
And obstructive lesions in the ascending and proximal trasnsverse co
Lon. 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 cereation ofcolostomy.
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 abdo
Men was 'explored through a mid-line incision and resection of the colonic
Lesion was done on the standered fashion according to the indication. Af
Ter mechanical cleansing of a proximal colonic segment, the lumen of the
Proximal colon is everted and an ordinary condom tube is sutured to the
Mncosa of the proximal segment, 3-5 cm proximal to the anastomotic line.
The tube is then spreadednp andposteriorlayer pftheanatbrnosisis
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 cas
Es of peritonitis secondary to perforated diverticulths. In 3 cases, sigmoid
Colectomyfor volvulus, and anterior resectionfor 2 cases of rectal carci-
Tages, which makes it the proce
Dure of choice in elective suituation.
One major block to the per
Formance of a primary anasto
Mosis in acute left-sided obstruc
Tion is proximal faecal loading.
Methods for dealing with this im
Portant adverse factor have been
Described: namely subtotal colectomy
And intra-operative colonic
Lavage (peter et al., 1995).
The three-stage procedure of
The initial defunctioning colostomy,
Followed by resection anas
Tomosis and subsequent colostomy
Closure, is now less commonly
Used because of the increased
Cummulative morbidity, mortality
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