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    • Resection and Primary Anastomosis without Colonic Lavage in NonMalignant Left Colon Emergency Conditions, Is it a Safe

    Shady Elghazaly Harb, Sherif M. Mokhtar, Sameh Mikhail
    General Surgery Department, Emergency Unit, Kasr Alaini University Hospital, Cairo University

    Background: Intra-operative colonic lavage is a widespread procedure introduced to decompress and clean the colon of its faecal load during emergency surgery of the left colon in order to perform a safe anastomosis. Objective: We planned our study not to perform colonic lavage in the included cases in order to figure out its feasibility and safety on single stage resection and anastomosis of the left colon in nonmalignant emergency surgeries in a series of patients according to certain inclusion criteria. Patients and methods: this is a prospective study that included 38(thirty eight) patients with acute, non-malignant, obstruction or perforation of the left colon admitted to the emergency department, Kasr Alaini University hospital, faculty of medicine, Cairo University between October 2014 and October 2016. They underwent a one stage resection and anastomosis without colonic lavage. The exclusion criteria for anastomosis were: haemodynamic instability and American Society of Anaesthesiologists (ASA) grade >3. Anastomotic leak and surgical site infection were the main outcome measures. Results: all the 38 patients were subjected to a single stage left colon resection and anastomosis being performed without colonic lavage (21 with obstruction and 17 with perforation). The leak rate was 7.8 % (3 cases) out of the 38 patients that were evidenced by bowel contents in the drainage fluid. A 21 % morbidity rate was recorded due to 8 surgical site infections. Conclusion: The procedure is safe. The low morbidity and mortality of one stage resection and anastomosis without colonic lavage of the left colon can justify future prospective studies including a larger number of patients to compare its results with those obtained by one stage resection with colonic lavage. Keywords: Colon resection, obstruction, perforation, anastomosis, intra-operative colonic lavage.

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