Is colonic lavage a suitable alternative for left-sided colonic emergencies?

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Gastroenterology

Background:

• Intra-operative colonic lavage (IOCL) use in emergency left-sided large bowel pathologies is debated.
• Alternatives include Hartmann's procedure, manual decompression, and subtotal colectomy.

Purpose of the Study:

• To compare peri-operative outcomes of IOCL with alternative surgical procedures.
• Evaluate the safety and efficacy of IOCL in emergency colonic surgery.

Main Methods:

• Systematic review and meta-analysis of electronic databases up to July 13, 2020.
• Inclusion of 28 studies with 1142 patients undergoing IOCL and 634 undergoing other interventions.
• Estimation of odds ratios and weighted mean differences for dichotomous and continuous outcomes.

Main Results:

• IOCL demonstrated comparable wound infection rates to Hartmann's procedure.
• Anastomotic leak and wound infection rates were similar between IOCL and manual decompression.
• IOCL was associated with a significantly decreased length of hospital stay compared to manual decompression (WMD = -7.750, P = 0.008).
• Overall mortality with IOCL was 4%, anastomotic leak 3%, and wound infection 12%.

Conclusions:

• IOCL presents comparable post-operative complication rates to alternative procedures for emergency left-sided colonic surgery.
• Further extensive research is warranted to fully elucidate the outcomes associated with IOCL in this patient population.