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Surgical options for left-sided large bowel emergencies.

J Pain1, J Cahill

  • 1King's College Hospital, London.

Annals of the Royal College of Surgeons of England
|November 1, 1991
PubMed
Summary

Hartmann's procedure is the preferred surgery for left-sided large bowel emergencies, including sigmoid carcinoma and diverticular disease. Most surgeons avoid proximal stomas or on-table lavage for primary anastomosis.

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Area of Science:

  • Colorectal Surgery
  • Surgical Decision-Making
  • Emergency Medicine

Background:

  • Left-sided large bowel emergencies present complex surgical challenges.
  • Optimal operative strategies for conditions like obstructing sigmoid carcinoma and diverticular disease require clear consensus.
  • Surgeon preferences and practices significantly influence treatment pathways.

Purpose of the Study:

  • To survey current surgical practices for left-sided large bowel emergencies.
  • To identify preferred operative procedures for obstructing sigmoid carcinoma and diverticular disease.
  • To understand variations in surgical techniques, including anastomosis protection and lavage.

Main Methods:

  • A questionnaire was distributed to 218 consultant surgeons.
  • The survey focused on operative choices for specific emergency scenarios.
  • A high response rate of 92% ensured robust data collection.

Main Results:

  • Hartmann's procedure is the most frequently chosen operation for all evaluated conditions.
  • Primary anastomosis after sigmoid colectomy is common for obstructing carcinomas (40%) but less so for other emergencies.
  • On-table lavage is rarely utilized, and most anastomoses are not protected by a proximal stoma.

Conclusions:

  • Hartmann's procedure remains the dominant surgical approach for left-sided large bowel emergencies.
  • There is variability in the use of primary anastomosis, with less frequent application in non-carcinoma emergencies.
  • Current practice generally favors omitting proximal stoma protection and on-table lavage for anastomoses.

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