One-stage resection and anastomosis for acute obstruction of the left colon

The purpose of this study was to analyze a single surgeon's experience with one-stage resection with primary anastomosis in acute obstruction of the left colon, emphasizing intraoperative decompression before the anastomosis.

From January 1986 to September 1996, 91 patients received one-stage resection with primary anastomosis for acute obstruction of the left colon. Eighty-five of these 91 patients were operated on for carcinoma of the colon and rectum. Subtotal colectomies were performed in 20 patients, left hemicolectomies in 21 patients, sigmoid colectomies in 34 patients, and anterior resections in 16 patients. The preoperative serum albumin level was less than 3 gm/dl in 17 patients (less than 2.5 gm/dl in 10 patients). Four patients had associated abscesses, and one patient had colonic perforation with peritonitis before operative colonoscopy. Neither antegrade nor retrograde irrigation was performed.

Operative mortality rate was 2.2 percent. There were two cases (2.2 percent) of anastomotic leakages. Other common complications included wound infection (11 cases), urinary tract infection (5 cases), intestinal obstruction (6 cases), and respiratory failure (3 cases).

This experience suggests that an anastomosis can be performed more safely in patients with acute obstruction of the left colon than in those with an anastomosis in the nondiverted colon. Neither intraoperative irrigation nor routine subtotal colectomy was found to be necessary. Anastomosis below the peritoneal reflection is also not a contraindication.