Management of left sided colorectal emergencies. Results of a postal questionnaire

Controversy continues over management of left sided colorectal emergencies. Historically, management was by a three-staged procedure but more recently a two-staged procedure (Hartmann's) was adopted. Since Dudley's description of the safety of peroperative antegrade colonic irrigation and primary anastomosis (PA) in the 1980s, some surgeons have adopted this one staged procedure. Studies have reported good outcomes. However, uptake of a one-staged approach is by no means universal. The aim of this study was to establish the operative choices of surgeons for emergency left sided colonic pathologies. We also compared the operative choices of colorectal surgeons, with non-colorectal surgeons.

A paper questionnaire was sent out to 300 consultant surgeons, equally to colorectal and non-colorectal surgeons practising in UK. They were asked to state their specialist surgical interest and which operation they would perform for: obstructed sigmoid carcinoma; obstructed sigmoid colon due to diverticular stricture; perforated sigmoid carcinoma; diverticulitis and purulent peritonitis; perforated diverticulitis with faecal peritonitis.

Of the 300 questionnaires sent out 145 (48%) were returned. Of these 72 (50%) were colorectal surgeons, 58 (40%) were non colorectal surgeons. For obstructed sigmoid carcinoma, obstruction due to diverticular stricture and purulent diverticulitis, colorectal surgeons were statistically more likely to perform PA than non-colorectal surgeons.

Our study indicates that colorectal surgeons are more likely to perform a single stage operation for all scenarios examined. It also shows that the attitude of surgeons in UK is changing and more are accepting the concept of specialistic management in complex colonic pathologies.