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Intraoperative colonic lavage in nonelective surgery for diverticular disease

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

BACKGROUND: Staged resection of the sigmoid colon has been the traditional strategy for treating patients who require nonelective surgery to manage complications of diverticular disease. Resection and primary anastomosis has not generally been recommended when the clinical setting is compromised by contiguous inflammation or inadequate mechanical cleansing of the colon because of concerns regarding the potential risk of anastomotic dehiscence. Although many reports have confirmed that intraoperative colonic lavage (ICL) is a safe method for relieving fecal loading of the colon to facilitate primary intestinal anastomosis in patients with mechanical obstruction of the distal colon, there is very limited experience with the use of this technique in treating acute inflammatory disorders of the colon. In this report, we present our results with ICL in the nonelective treatment of patients with complications of diverticulitis. METHODS: Records of all patients undergoing urgent operations at the Lahey Clinic to treat complications of diverticular disease from July 1987 to January 1996 were reviewed. RESULTS: Of 62 patients who required nonelective operations, 33 underwent ICL in an attempt to perform primary anastomosis. In five patients, the operation included creation of a colostomy. The indication for surgery was obstruction in 13 patients (39 percent), persistent abscess or phlegmon in 13 (39 percent), perforation in 6 patients (18 percent), and hemorrhage in 1 patient (3 percent). According to Hinchey's classification system, 18 patients had Stage I disease, 10 had Stage II, and 5 patients had Stage III disease. There were no patients with Stage IV disease. The single anastomotic complication in the series was responsible for the sole operative mortality. The morbidity rate of 42 percent, included three intraoperative complications (2 splenic injuries and 1 ureteral laceration), two intra-abdominal abscesses (6 percent), and six wound infections (18 percent). CONCLUSION: In our experience, ICL has proven to be a safe method for accomplishing single-stage resection of the colon in selected patients with diverticulitis who require an urgent operation. When there is no evidence of diffuse purulent or feculent peritonitis, we believe this is the preferred method for treating patients who are hemodynamically stable.

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References

  1. Almy TP, Howell DA. Diverticular disease of the colon. N Engl J Med 1980;302:324–31.

    Article  PubMed  CAS  Google Scholar 

  2. Parks TG. Natural history of diverticular disease of the colon. Clin Gastroenterol 1975;4:53–69.

    PubMed  CAS  Google Scholar 

  3. Rothenberger DA, Wiltz O. Surgery for complicated diverticulitis. Surg Clin North Am. 1993;73:975–92.

    PubMed  CAS  Google Scholar 

  4. Parks TG. Natural history of diverticular disease of the colon: a review of 521 cases. BMJ 1969;4:639–45.

    Article  PubMed  CAS  Google Scholar 

  5. Rodkey GV, Welch CE. Changing patterns in the surgical treatment of diverticular disease. Ann Surg 1984;200:466–78.

    PubMed  CAS  Google Scholar 

  6. Ambrosetti P, Robert JH, Witzig JA,et al. Acute left colon diverticulitis: a prospective analysis of 226 consecutive cases. Surgery 1994;115:546–50.

    PubMed  CAS  Google Scholar 

  7. Hackford AW, Schoetz DJ Jr, Coller JA, Veidenheimer MC. Surgical management of complicated diverticulitis: The Lahey Clinic Experience, 1967 to 1982. Dis Colon Rectum 1985;28:317–21.

    PubMed  CAS  Google Scholar 

  8. Finlay IG, Carter DC. A comparison of emergency resection and staged management in perforated diverticular disease. Dis Colon Rectum 1987;30:929–33.

    PubMed  CAS  Google Scholar 

  9. Nagorney DM, Adson MA, Pemberton JH. Sigmoid diverticulitis with perforation and generalized peritonitis. Dis Colon Rectum 1985;28:71–5.

    PubMed  CAS  Google Scholar 

  10. Carty NJ, Corder AP, Johnson CD. Colostomy is no longer appropriate in the management of uncomplicated large bowel obstruction: true or false? Ann R Coll Surg Engl 1993;75:46–51.

    PubMed  CAS  Google Scholar 

  11. Murray JJ, Schoetz DJ, Coller JA, Roberts PL, Veidenheimer MC. Intraoperative colonic lavage and primary anastomosis in nonelective colon resection. Dis Colon Rectum 1991;34:527–31.

    Article  PubMed  CAS  Google Scholar 

  12. Scott HJ, Lane IF, Glynn MJ. Colonic hemorrhage: a technique for rapid intra-operative bowel preparation and colonoscopy. Br J Surg 1986;73:390–1.

    PubMed  CAS  Google Scholar 

  13. Hinchey EJ, Schaal PG, Richards GK. Treatment of perforated diverticular disease of the colon. Adv Surg 1978;12:85–109.

    PubMed  CAS  Google Scholar 

  14. Scott-Conner CE, Scher KS. Implications of emergency operations on the colon. Am J Surg 1987;153:535–40.

    Article  PubMed  CAS  Google Scholar 

  15. Irvin GL, Horsley S, Caruana JA. The morbidity and mortality of emergent operations for colorectal disease. Ann Surg 1984;199:598–603.

    PubMed  Google Scholar 

  16. Gordon PH. Diverticular disease of the colon. In: Gordon PH, Nivatvongs S. Principles and practice of surgery for the colon, rectum and anus. St. Louis: Quality Medical Publishing, 1992.

    Google Scholar 

  17. Hulkko OA, Laitinen ST, Haukipuro HA, Stahlberg MJ, Juvonen TS, Kairaluoma MI. The Hartmann procedure for the treatment of colorectal emergencies. Acta Cir Scand 1986;152:531–53.

    CAS  Google Scholar 

  18. Ravo B, Metwally N, Castera P, Polansky PJ, Ger R. The importance of intraluminal anastomotic fecal contact and peritonitis in colonic anastomotic leakage. Dis Colon Rectum 1988;31:868–71.

    PubMed  CAS  Google Scholar 

  19. Tornqvist A, Forsgren A, Faldt K, Jiborn H, Zederfeldt B. Bacterial load and inflammatory reaction in the bowel wall after colonic obstruction. Eur J Surg 1991;157:539–54.

    PubMed  CAS  Google Scholar 

  20. Smith SR, Connolly JC, Gilmore OJ. The effect of faecal loading on colonic anastomotic healing. Br J Surg 1983;70:49–50.

    PubMed  CAS  Google Scholar 

  21. Tornqvist A, Blomquist P, Jiborn H, Zederfeldt B. Anastomotic healing after resection of left colon stenosis: effect on collagen matabolism and anastomotic strength. Dis Colon Rectum 1990;33:217–21.

    Article  PubMed  CAS  Google Scholar 

  22. Irvin TT, Goligher JC. Aetiology of disruption of intestinal anastomoses. Br J Surg 1973;60:462–4.

    Google Scholar 

  23. Irvin TT. Collagen metabolism in infected colonic anastomoses. Surg Gynecol Obstet 1976;143:220–4.

    PubMed  CAS  Google Scholar 

  24. Tornqvist A, Jiborn H, Zederfeldt B, Forsgren A. Perioperative contamination and anastomotic leakage after resection for left colon stenosis. Int J Colorectal Dis 1990;5:164–6.

    Article  PubMed  CAS  Google Scholar 

  25. Schrock TR, Deveney CW, Dunphy JE. Factors contributing to leakage of colonic anastomosis. Ann Surg 1973;177:513–8.

    PubMed  CAS  Google Scholar 

  26. Stephenson BM, Shandall AA, Farouk R, Griffin G. Malignant left-sided large bowel obstruction managed by subtotal/total colectomy. Br J Surg 1990;77:1098–102.

    PubMed  CAS  Google Scholar 

  27. Brief DK, Brener BJ, Goldenkranz R,et al. Defining the role of subtotal colectomy in the treatment of carcinoma of the colon. Ann Surg. 1991;213:248–52.

    PubMed  CAS  Google Scholar 

  28. Radcliffe AG, Dudley HA. Intraoperative antegrade irrigation of the large intestine. Surg Gynecol Obstet 1983;156:721–3.

    PubMed  CAS  Google Scholar 

  29. Koruth NM, Krukowski ZH, Youngson GG,et al. Intraoperative colonic irrigation in the management of leftsided large bowel emergencies. Br J Surg 1985;72:708–11.

    PubMed  CAS  Google Scholar 

  30. Pollock AV, Playforth MJ, Evans BA. Perioperative lavage of the obstructed left colon to allow safe primary anastomosis. Dis Colon Rectum 1987;30:171–3.

    PubMed  CAS  Google Scholar 

  31. Tan SG, Nambia R, Rauff A, Ngoi SS, Goh HS. Primary resection and anastomosis in obstructed descending colon due to cancer. Arch Surg 1991;126:748–50.

    PubMed  CAS  Google Scholar 

  32. Stewart J, Diament RH, Brennan TG. Management of obstructing lesions of the left colon by resection, on-table lavage, and primary anastomosis. Surgery 1993;114:502–5.

    PubMed  CAS  Google Scholar 

  33. Thomson WH, Carter SS. On table lavage to achieve safe restorative rectal and emergency left colonic resection without covering colostomy. Br J Surg 1986;73:61–3.

    PubMed  CAS  Google Scholar 

  34. West of Scotland and Highland Anastomosis Study Group. Suturing or stapling in gastrointestinal surgery: a prospective randomized study. Br J Surg 1991;78:337–4.

    Google Scholar 

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Author notes

  1. Edward C. Lee M.D.

    Present address: Section of Colorectal Surgery, Department of Surgery, Albany Medical Center, 47 New Scotland Avenue, 12208, Albany, New York

Authors and Affiliations

  1. Department of Colon & Rectal Surgery, Lahey Hitchcock Clinic, 41 Mall Road, 01805, Burlington, Massachusetts

    Edward C. Lee M.D.,  John J. Murray M.D., John A. Coller M.D., Patricia L. Roberts M.D. & David J. Schoetz Jr. M.D.

Authors
  1. Edward C. Lee M.D.
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  2. John J. Murray M.D.
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  3. John A. Coller M.D.
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  4. Patricia L. Roberts M.D.
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  5. David J. Schoetz Jr. M.D.
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Additional information

Read at the meeting of The American Society of Colon and Rectal Surgeons, Seattle, Washington, June 9 to 14, 1996.

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Lee, E.C., Murray, J.J., Coller, J.A. et al. Intraoperative colonic lavage in nonelective surgery for diverticular disease. Dis Colon Rectum 40, 669–674 (1997). https://doi.org/10.1007/BF02140895

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  • DOI: https://doi.org/10.1007/BF02140895

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