Primary resection and anastomosis of lesions obstructing the left colon

It is becoming apparent that primary resection and anastomosis of the left colon for colonic obstruction is a feasible operation. This paper reviews 750 colonic resections at the Queen Elizabeth Hospital of Montreal, of which 40 were performed on unprepared bowel in patients with obstructed left colonic lesions. The pre- and postoperative hospital stay was greatly reduced. The death rate was 5% and complication rate 40%. Follow-up results suggest this procedure is safe and that an adequate cancer operation can be carried out. It should be stressed that not all obstructing left colonic lesions can be treated with a one-stage procedure and that the Hartmann procedure or a protective colostomy can always be used if the situation warrants it.