Skip to main content

Advertisement

SpringerLink
Log in

Single-stage procedure with intraoperative colonoscopy and colonic irrigation in patients with obstructing left-sided colonic cancer

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background and aims

Recently there has been growing acceptance of the one-stage resection and primary anastomosis with intraoperative antegrade irrigation. This study evaluated the efficacy of a newly developed device for performing a single-stage procedure in patients with obstructing left-sided colon cancer.

Patients and methods

A series of 151 consecutive patients with obstructing left-sided colonic cancer underwent on-table irrigation, resection, and primary anastomosis with the use of a newly developed device; 75 patients on-table colonoscopy. The study spanned a 3 years from September 1999 to August 2002. The observed variables were the volume of irrigated saline, time for irrigation and colonoscopic examination, synchronous pathology, operative mortality and morbidity, time to passage of flatus, restarting day of oral intake, and length of hospital stay.

Results

The mean volume of irrigated saline was a mean of 12.5 l (range 1–32) over a mean of 14.2 min (range 1–45). Subsequent colonoscopic examination added a mean of 10.7 min (range 3–15). The incidence of synchronous polyps was 47% (35 of 75 cases) in performing the on-table colonoscopic investigations. On-table colonoscopy induced surgeons to extend resection because of synchronous malignancy attested by frozen biopsy specimen in ten patients and because of mucosal necrosis of the proximal colon in three. There were two anastomotic leakages, six wound infections, and one operative mortality. The time to passage of flatus was an average of 3.6 days (range 1.0–7). The time to oral intake was an average of 4.3 days (range 3–8). The length of hospital stay was 11.7 days (range 6–43).

Conclusion

These findings suggest that our device is an effective tool to facilitate acceptance of the one-stage procedure in patients with obstructing left-sided colonic cancer. Specifically, our device enables quick and easy on-table colonoscopy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Naraynsingh V, Rampaul R, Maharaj D, Kuruvilla T, Ramcharan K, Pouchet B (1999) Prospective study of primary anastomosis without colonic lavage for patients with an obstructed left colon. Br J Surg 86:1341–1343

    Article  CAS  PubMed  Google Scholar 

  2. Biondo S, Jaurrieta E, Jorba R, Moreno P, Farran L, Borobia F, Bettonica C, Poves I, Ramos E, Alcobendas F (1997) Intraoperative colonic lavage and primary anastomosis in peritonitis and obstruction. Br J Surg 84:222–225

    CAS  PubMed  Google Scholar 

  3. Neri E, Giusti P, Battolla L, Vagli P, Boraschi P, Lencioni R, Caramella D, Bartolozzi C (2002) Colorectal cancer: role of CT colonography in preoperative evaluation after incomplete colonoscopy. Radiology 223:615–619

    PubMed  Google Scholar 

  4. Kressner U, Antonsson J, Ejerblad S, Gerdin B, Pahlman L (1994) Intraoperative colonic lavage and primary anastomosis; an alternative to Hartmann procedure in emergency surgery of the left colon. Eur J Surg 160:287–292

    CAS  PubMed  Google Scholar 

  5. Lau PW, Lo CY, Law WL (1995) The role of one-stage surgery in acute left-sided colonic obstruction. Am J Surg 169:406–409

    Article  CAS  PubMed  Google Scholar 

  6. SCOTIA Study Group (1995) Subtotal colectomy versus on-table Irrigation and anastomosis. Single-stage treatment for malignant left-sided colonic obstruction: a prospective randomized clinical trial comparing subtotal colectomy with segmental resection following intraoperative irrigation. Br J Surg 82:1622–1627

    PubMed  Google Scholar 

  7. Irvin TT, Greaney MG (1977) The treatment of colonic cancer presenting with intestinal obstruction. Br J Surg 64:741–744

    CAS  PubMed  Google Scholar 

  8. Stephenson BM, Shandall AA, Farouk R, Griffith G (1990) Malignant left-sided large bowel obstruction managed by subtotal/total colectomy. Br J Surg 77:1098–1102

    CAS  PubMed  Google Scholar 

  9. Dudley HA, Racliffe AG, McGeehan D (1980) Intraoperative irrigation of the colon to permit primary anastomosis. Br J Surg 67:80–81

    CAS  PubMed  Google Scholar 

  10. Lee EC, Murray JJ, Coller JA, Roberts PL, Schoetz DJ (1997) Intraoperative colonic lavage in nonelective surgery for diverticular disease. Dis Colon Rectum 40:669–674

    Google Scholar 

  11. Murray JJ, Schoetz DJ Jr, Coller JA, Roberts PL, Veidenfeimer MC (1991) Intraoperative colonic lavage and primary anastomosis in nonelective colon resection. Dis Colon Rectum 34:527–531

    CAS  PubMed  Google Scholar 

  12. Forloni B, Reduzzi, R, Paludetti, A, Coplani, L, Cavaralli, G, Frosali, D (1998) Intra-operative colonic lavage in emergency surgical treatment of left-sided colonic obstruction. Dis Colon Rectum 41:23–27

    CAS  PubMed  Google Scholar 

  13. Radcliffe AG, Dudley HA (1983) Intraoperative antegrade irrigation of the large intestine. Surg Gynecol Obstet 156:721–723

    CAS  PubMed  Google Scholar 

  14. Duraker N, Bender O (1998) Intraoperative bowel irrigation improves anastomotic collagen metabolism in the left sided colonic obstruction but not covering colostomy. Int J Colorectal Dis 13:232–234

    Article  CAS  PubMed  Google Scholar 

  15. Tan SG, Nambiar R, Rauff A, Ngoi SS, Goh HS (1991) Primary resection and anastomosis in obstructed descending colon due to cancer. Arch Surg 126:748–751

    CAS  PubMed  Google Scholar 

  16. Murray JJ (1991) Nonelective colon resection: Alternative to multistage resections. Surg Clin North Am 71:1187–1194

    CAS  PubMed  Google Scholar 

  17. Lee YM, Law WL, Chu KW, Poon RT (2001) Emergency surgery for obstructing colorectal cancers: a comparison between right-sided and left-sided lesions. J Am Coll Surg 192:719–725

    Article  CAS  PubMed  Google Scholar 

  18. Konishi F, Muto T, Kanazawa K, Morioka Y (1988) Intraoperative irrigation and primary resection for obstructing lesions of the left colon. Int J Colorectal Dis 3:204–206

    CAS  PubMed  Google Scholar 

  19. Passman MA, Pommier RF, Vetto JT (1996) Synchronous colon primaries have the same prognosis as solitary colon cancers. Dis Colon Rectum 39:329–334

    CAS  PubMed  Google Scholar 

  20. Huang EH, Whelan RL, Gleason NR, Maeda JS, Terry MB, Lee SW (2001) Increased incidence of colorectal adenomas in follow-up evaluation of patients with newly diagnosed hyperplastic polyps. Surg Endosc 15:646–648

    Article  CAS  PubMed  Google Scholar 

  21. Arenas RB, Fichera A, Mhoon D, Michelassi F (1997) Incidence and therapeutic implications of synchronous colonic pathology in colorectal adenocarcinoma. Surgery 122:706–710

    CAS  PubMed  Google Scholar 

  22. Takeuchi H, Toda T, Nagasaki S, Kawano T, Minamisono Y, Maehara Y (1997) Synchronous multiple colorectal adenocarcinomas. J Surg Oncol 64:304–307

    Article  CAS  PubMed  Google Scholar 

  23. Papatheodoridis GV, Triantafyllou K, Tzouvala M, Paspatis G, Xourgias V, Karamanolis DG (1996) Characteristics of rectosigmoid adenomas as predictors of synchronous advanced proximal colon neoplasms. Am J Gastroenterol 91:1809–1813

    CAS  PubMed  Google Scholar 

  24. Patel K, Hoffman NE (2001) The anatomical distribution of colorectal polyps at colonoscopy. J Clin Gastroenterol 33:222–225

    Article  CAS  PubMed  Google Scholar 

  25. Imperiale TF, Wagner DR, Lin CY, Larkin GN, Rogge JD, Ransohoff DF (2000) Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med 343:169–174

    Article  CAS  PubMed  Google Scholar 

  26. Levin TR, Palitz A, Grossman S, Conell C, Finkler L, Ackerson L, Rumore G, Selby JV (1999) Predicting advanced proximal colonic neoplasia with screening sigmoidoscopy. JAMA 281:1611–1617

    Article  CAS  PubMed  Google Scholar 

  27. Koruth NM, Krukowski ZH, Youngson GG, Hendry WS, Logie JR, Jones PF, Munro A (1985) Intra-operative colonic irrigation in the management of left-sided large bowel emergencies. Br J Surg 72:708–711

    CAS  PubMed  Google Scholar 

  28. Foster ME, Johnson CD, Billings PJ, Davies PW, Leaper DJ (1986) Intraoperative antegrade lavage and anastomotic healing in acute colonic obstruction. Dis Colon Rectum 29:255–259

    CAS  PubMed  Google Scholar 

  29. Pollock AV, Playforth MJ, Evans M (1987) Peroperative lavage of the obstructed left colon to allow safe primary anastomosis. Dis Colon Rectum 30:171–173

    CAS  PubMed  Google Scholar 

  30. Ambrosetti P, Borst F, Robert J, Meyer P, Rohner A (1989) Single-stage excision anastomosis of left colonic obstruction excision treated as an emergency (in French). Chirurgie [Suppl 2] I–VII:115

Download references

Acknowledgements

This research was presented at the 14th Annual Colorectal Disease Symposium, Cleveland Clinic Florida, 15 February 2003.

Author information

Authors and Affiliations

  1. Department of Surgery, College of Medicine, Kon-Kuk University, Chungju, Korea

    Ung Chae Park, Soon Sup Chung, Kyong Rae Kim & Moo Kyung Seong

  2. Chungnam National University Hospital, Daejeon, Korea

    Wan Hee Yoon

  3. Chonnam National University Hospital, Gwangju, Korea

    Young Jin Kim

  4. Hanyang University Hospital, Guri, Korea

    Hong Kyu Baik

  5. Ulsan University Asan Medical Center, Seoul, Korea

    Chang Sik Yu

  6. Yeungnam University Medical Center, Daegu, Korea

    Jae Hwang Kim

Authors
  1. Ung Chae Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Soon Sup Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kyong Rae Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Moo Kyung Seong
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wan Hee Yoon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Young Jin Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hong Kyu Baik
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Chang Sik Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jae Hwang Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ung Chae Park.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Park, U.C., Chung, S.S., Kim, K.R. et al. Single-stage procedure with intraoperative colonoscopy and colonic irrigation in patients with obstructing left-sided colonic cancer. Int J Colorectal Dis 19, 487–492 (2004). https://doi.org/10.1007/s00384-004-0584-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-004-0584-6

Keywords

Search

Navigation