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 trasnsverse 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 cob-rectal anastomosis without cereation of colostomy.
It inch I r kid 16 patients, 12 (75%) males and 4 (25%) fernolPs 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 standered 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
mue osa of the proximal segment, 3-5 cm proximal to the anastomotic line.
The tube is then spreadPd up and posterior layer of the artatomosis 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 card- nomas. The mean time length for fixation of the by-pass tube was
(11.06+1.95) minutes. The mean length of whole surgical procedures was
(130.9+17.6) minntes, 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 04.25 + 8.6) days. In the other
2 patients the tube could not be identified after a period of 32 days follow
up.
Pulmorary 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 arzastomotic stenosis developed in our patients.
To conclude, the technique of one stage isolated left colonic anastornosis
can be a subistitute for staged colonic resection in acute corditions of
the left colon and in high risk anastomosis . |
