Intra-operative colonic lavage: safe single-stage, left colorectal resections

Fifty consecutive left-sided colorectal cases are described in which intra-operative colonic lavage (IOCL) was used. Sixteen were acute or sub-acute cases, including five with total colonic obstruction. The anastomoses were usually hand-sutured and no colostomies were used: all procedures were single stage. Only one case was considered to have possibly had an anastomotic leak (2.0%) and the average hospital stay was 16 days. There were 3 wound infections (6%). Peri-operative mortality was 6% and no deaths occurred in the acute or sub-acute cases. The procedure allows safe one-stage operation in most acute left-sided colonic lesions and provides the most thorough colonic preparation for elective cases, thus obviating the need for colostomy in cases where the colon is found to be inadequately prepared, or in very low anastomoses. The technique described for IOCL is readily reproduced, attendant with negligible risk of complications and takes relatively little extra operating time. Defunctioning colostomy is unlikely to be necessary with this method, thereby saving patients considerable discomfort and nuisance, time in hospital and the potential morbidity of further operation. Specific recommendations for use of IOCL are: acute or sub-acute left colonic obstruction: stenosing or volvulus; massive colonic haemorrhage: for diagnostic and preparatory use; rectal and left colonic trauma; left colonic surgery where inadequate pre-operative bowel preparation has occurred; 'low' elective restorative rectal resection; and preparation for colonic replacement of oesophagus.