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Prospective, Randomized Trial Comparing Intraoperative Colonic Irrigation With Manual Decompression Only for Obstructed Left-Sided Colorectal Cancer

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Diseases of the Colon & Rectum

BACKGROUND

This is a prospective, randomized, controlled trial comparing the outcome of intraoperative colonic irrigation with that of manual decompression for acutely obstructing colorectal cancers distal to the splenic flexure.

METHODS

All patients admitted to our department from June 1999 to August 2002 with obstructing left-sided colorectal cancers were recruited. Patients were randomized intraoperatively and were excluded if deemed unsuitable for segmental resection and primary anastomosis. Twenty-five patients were randomized to receive colonic irrigation and twenty-eight to receive manual decompression. Perioperative parameters and outcome including mortality and anastomotic leak were recorded.

RESULTS

Both groups of patients were comparable in terms of gender and age. The time taken for mobilization, decompression, and irrigation in the colonic irrigation group (median, 31 minutes) was significantly longer than that for the manual decompression group (median, 13 minutes) (P; = 0.0005). However, the total time of the operation was similar for both groups. Times for recovery of bowel function, of wound infection, and until discharge from the hospital were also similar. In the manual decompression group there were two cases of anastomotic leak (8 percent, 2/25) requiring reoperation but none (0/24) in the colonic irrigation group. However, this difference was not statistically significant.

CONCLUSION

Manual decompression of proximal colon without irrigation is as safe as colonic irrigation in one-stage surgical management of obstructing left-sided colorectal cancer.

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REFERENCES

  1. HA Dudley AG Radcliffe D McGeehan (1980) ArticleTitleIntraoperative irrigation of the colon to permit primary anastomosis Br J Surg 67 80–1 Occurrence Handle1:STN:280:Bi%2BC2MvjvFc%3D Occurrence Handle7362953

    CAS  PubMed  Google Scholar 

  2. AV Pollock MJ Playforth M Evans (1987) ArticleTitlePeroperative lavage of the obstructed left colon to allow safe primary anastomosis Dis Colon Rectum 30 171–3 Occurrence Handle1:STN:280:BiiC287hs1E%3D Occurrence Handle3829858

    CAS  PubMed  Google Scholar 

  3. JJ Murray DJ Schoetz JA Coller PL Roberts MC Veidenheimer (1991) ArticleTitleIntraoperative colonic lavage and primary anastomosis in nonelective colon resection Dis Colon Rectum 34 527–31 Occurrence Handle1:STN:280:By6B2srmslA%3D Occurrence Handle2055137

    CAS  PubMed  Google Scholar 

  4. H Mochizuki E Nakamura K Hase S Tamakuma (1993) ArticleTitleThe advantage of primary resection and anastomosis with intraoperative bowel irrigation for obstructing left-sided colorectal carcinoma Surg Today 23 771–6

    Google Scholar 

  5. DC Nyam AF Leong YH Ho F Seow-Choen (1996) ArticleTitleComparison between segmental left and extended right colectomies for obstructing left-sided colonic carcinomas Dis Colon Rectum 39 1000–3

    Google Scholar 

  6. RT Poon WL Law KW Chiu J Wong (1998) ArticleTitleEmergency resection and primary anastomosis for left-sided obstructing colorectal carcinoma in the elderly Br J Surg 85 1539–42

    Google Scholar 

  7. B Forloni R Reduzzi A Paludetti L Colpani G Cavallari D Frosali (1998) ArticleTitleIntraoperative colonic lavage in emergency surgical treatment of left-sided colonic obstruction Dis Colon Rectum 41 23–7

    Google Scholar 

  8. TC Hsu (1998) ArticleTitleOne-stage resection and anastomosis for acute obstruction of the left colon Dis Colon Rectum 41 28–32

    Google Scholar 

  9. A Chiappa A Zbar F Biella C Staudacher (2000) ArticleTitleOne-stage resection and primary anastomosis following acute obstruction of the left colon for cancer Am Surg 66 619–22 Occurrence Handle1:STN:280:DC%2BD3czptVCjtA%3D%3D Occurrence Handle10917469

    CAS  PubMed  Google Scholar 

  10. A Pisanu S Piu ML Altana A Uccheddu (2002) ArticleTitleOne-stage treatment of obstructing colorectal cancer Chir Ital 54 267–74

    Google Scholar 

  11. DC Nyam F Seow-Choen AF Leong YH Ho (1996) ArticleTitleColonic decompression without on-table irrigation for obstructing left-sided colorectal tumours Br J Surg 83 786–7

    Google Scholar 

  12. V Naraynsingh R Rampaul D Maharaj et al. (1999) ArticleTitleProspective study of primary anastomosis without colonic lavage for patients with an obstructed left colon Br J Surg 86 1341–3

    Google Scholar 

  13. U De S Ghosh (2003) ArticleTitleSingle-stage primary anastomosis without colonic lavage for left-sided colonic obstruction due to acute sigmoid volvulus: a prospective study of one hundred and ninety seven cases ANZ J Surg 73 390–2

    Google Scholar 

  14. F Seow-Choen KW Eu (1993) ArticleTitleIntraoperative irrigation for acute distal colonic obstruction caused by carcinoma Br J Surg 80 516

    Google Scholar 

  15. N Duraker O Bender K Memisoglu A Yalciner (1998) ArticleTitleIntraoperative bowel irrigation improves anastomotic collagen metabolism in the left-sided colonic obstruction but not covering colostomy Int J Colorectal Dis 13 232–4 Occurrence Handle10.1007/s003840050167 Occurrence Handle1:STN:280:DyaK1M%2Fos12qsw%3D%3D Occurrence Handle9870167

    Article  CAS  PubMed  Google Scholar 

  16. ME Foster CD Johnson PJ Billings PW Davies DJ Leaper (1986) ArticleTitleIntraoperative antegrade lavage and anastomotic healing in acute colonic obstruction Dis Colon Rectum 29 255–9

    Google Scholar 

  17. P Brownson S Jenkins D Nott S Ellenbogen (1992) ArticleTitleMechanical bowel preparation before colorectal surgery: results of a prospective randomized trial Br J Surg 79 461–2

    Google Scholar 

  18. P Burke K Mealy P Gillen W Joyce O Traynor J Hyland (1994) ArticleTitleRequirement for bowel preparation in colorectal surgery Br J Surg 81 907–10

    Google Scholar 

  19. JC Santos J Batista MT Sirimarco AS Guimaraes CE Levy (1994) ArticleTitleProspective randomized trial of mechanical bowel preparation in patients undergoing elective colorectal surgery Br J Surg 81 1673–6 Occurrence Handle7827905

    PubMed  Google Scholar 

  20. RP Meittinen ST Laitinen JT Makela ME Paakkonen (2000) ArticleTitleBowel preparation with oral polyethylene glycol electrolyte solution <mdit>vs.<med> no preparation in elective open colorectal surgery: prospective randomized study Dis Colon Rectum 43 669–77 Occurrence Handle1:STN:280:DC%2BD3c3osVKlsA%3D%3D Occurrence Handle10826429

    CAS  PubMed  Google Scholar 

  21. D Geldere ParticleVan P Fa-Si-Oen LA Noach PJ Rietra JL Peterse RP Boom (2002) ArticleTitleComplications after colorectal surgery without mechanical bowel preparation J Am Coll Surg 194 40–7 Occurrence Handle11803955

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore

    J. F. Lim F.R.C.S. (Glasg.), C.-L. Tang F.R.C.S. (Edinb.), F. Seow-Choen F.R.C.S (Edinb.) & S. M. Heah F.R.C.S. (Edinb.)

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  1. J. F. Lim F.R.C.S. (Glasg.)
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  2. C.-L. Tang F.R.C.S. (Edinb.)
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  3. F. Seow-Choen F.R.C.S (Edinb.)
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  4. S. M. Heah F.R.C.S. (Edinb.)
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Published online: 28 January 2005.

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Lim, J., Tang, CL., Seow-Choen, F. et al. Prospective, Randomized Trial Comparing Intraoperative Colonic Irrigation With Manual Decompression Only for Obstructed Left-Sided Colorectal Cancer. Dis Colon Rectum 48, 205–209 (2005). https://doi.org/10.1007/s10350-004-0803-9

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  • DOI: https://doi.org/10.1007/s10350-004-0803-9

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