Prospective study of primary anastomosis without colonic lavage for patients with an obstructed left colon

BACKGROUND: Traditionally, left-sided colon obstruction is managed by a multistaged defunctioning colostomy and resection. However, there is growing acceptance of one-stage primary resection and anastomosis with on-table antegrade irrigation. This paper presents a series of patients managed prospectively by primary anastomosis without intraoperative colonic lavage. METHODS: Emergency resection of acutely obstructed left-sided colonic carcinomas was performed. This was followed by primary anastomosis without on-table lavage after bowel decompression using a new technique. RESULTS: Fifty-eight consecutive, unselected patients underwent bowel decompression, resection and primary colocolic anastomosis. Only one patient developed a leak at the anastomotic site, requiring pelvic abscess drainage and transverse loop colostomy. One death occurred 12h following surgery. Autopsy confirmed that this was due to myocardial infarction. Mean hospital stay was 9.8 days. CONCLUSION: Emergency surgery on the obstructed left colon can be carried out safely after decompression alone, without intraoperative colonic lavage (AU)

Transperitoneal exclusion: a simple third world solution for abdominal aortic aneurysm

We present an operation never described before for dealing with abdominal aortic aneurysms by exclusion via a midline trans-abdominal approach. This breakthrough holds many advantages over conventional aneurysmorrahphy and requires further clinical trials (AU)

Necrotising enterocolitis: A management protocol for developing countries

28 cases of necrotising enterocolitis (NEC) comprising 11 term and 17 preterm patients were diagnosed between January 1990 and December 1995 at the University Hospital of the West Indies (UHWI). Treatment was in accordance with a management protocol which emphasised aggressive screening of potential cases, early laparotomy for bowel perforation and primary anastomosis after small bowel resection. There were three deaths among the 13 cases of bowel perforation. Centres in developing countries can achieve rates of survival comparable to those in the developed world in babies with NEC weighing over 1000 grams by adopting the UHWI management protocol.(AU)

Hartmann's operation: does it still have a place? - abstract

In 1923 Hartmann described an operation where, for an advanced rectal carcinoma, he completely excluded the rectum and brought out an end sigmoid colostomy. Since then, this procedure has been widely used for cases where rectal anastomosis is regarded as unsafe. In 23 consecutive cases in which Hartmann's operation was indicated (gangrenous sigmoid volvulus 3, trauma 6, pelvic sepsis 9, tumour 6) the authors elected to do an "unsafe" anastomosis with a totally defunctioning proximal colostomy. Only two (2) cases developed complications (minor). Hartmann's operation should only be done in the situation where there is absolutely no intention to restore gut continuity as pelvic dissection to reconstitute the gut can be very difficult. If rectal anastomosis is regarded as unsafe it should still be carried out and a defunctioning colostomy done since the second stage only involves colostomy closure (AU)

Colo-mucosal proctectomy with ileo-anal anastomosis: the Jamaican experience

A total colectomy and a mucosal proctectomy with ileo-anal anastomosis (c-mp-iaa) effectively removes all debilitating, potentially malignant colonic mucosa. Preservation of the anorectal sphincter predictably results in good to excellent anal continence with a low mortality and acceptable morbidity. Since 1983 at the University Hospital of the West Indies (U.H.W.I.), Jamaica, five (5) patients have undergone c-mp-iaa for colonic mucosal disease. All have good to excellent anal continence with an average of 2-6 continent, formed stools per day. There were no operative deaths. The five (5) cases are described and a plea is made for the earlier use of this definitive surgical procedure where indicated. (AU)

Obstructed left colon: one stage surgery in a developing country

Thirty-two consecutive cases of left-sided colonic obstruction are presented. Thirty cases were managed by primary resection and anastomosis without colostmy. No anastomotic leakage occurred. This procedure allowed significant conservation of material and personnel resources with minimal patient morbidity (AU)

Primary repair of anastomosis in emergency colonic surgery - abstract

Standard surgical practice still dictates that in the unprepared column the staged procedures of colostomy, bowel preparation and elective surgery should be done in preference to primary repair or resection and anastomosis. Because this traditional practice involves multiple operations with increased hospitalization, operation time, drug requirements and morbidity, a practice of routine one-stage repair in emergency colonic surgery was prospectively adopted from 1984. Since then, 45 emergency colonic operations were performed. Primary repair or resection and anastomosis were done in 41 cases (30 traumatic injuries, 9 left-sided obstructions and 2 others). Colostomy was performed in 4 cases where it was not regarded as technically possible or safe to carry out primary repair or anastomosis. The only anastomotic leak in 41 cases of primary repair or anastomosis resulted in minimal morbidity. Because of tremendous savings through use of a one-stage procedure, and the low complication rate, primary repair of anastomosis should be considered the treatment of choice in most emergency colonic operations (AU)

Evaluation of reversal of sterilization by tubo-tubal anastomosis: a study of 53 cases - abstract

This series comprises 53 cases of tubal anastomosis performed from 1968 to 1978. Patients who were selected for anastomosis had had ligation performed in the puerperium or as an adjunct to abortion. The main reason for ligation was multiparity associated with financial and economic stress. No case of blocked tubes as a result of inflammation has been included. Prior to operation it was made clear to all patients that this major operation is not expected to be 100 percent successful and carries the possibility of future abortion or ectopic pregnancy. The preoperative demonstration by hysterosalpingogram of a relatively long uterine stump is likely to be associated with a more successful result. Conception was achieved in 38 (72 percent) of the operated cases, after a period of 3 months to 6 years. There were 3 cases of abortion. There were no ectopic pregnancies recorded. Eight cases emigrated and seven failed to return for follow up. One lady had 3 children in 5 years and was litigated again by request (AU)