Safioleas Michael, Stamatakos Michael, Safioleas Panayoitis, Safioleas Konstantinos, Sakorafas George H
2nd Department of Propaedeutic Surgery, Laikon General Hospital, Athens University Medical School, Athens, Greece.
Am Surg. 2011 Apr;77(4):447-50.
Management of surgical emergencies of the left colon commonly requires excision of the colonic segment bearing the lesion, creation of an end colostomy, and closure of the rectosigmoid stump. Closure of the end stoma may be technically challenging. During this study, we used a new surgical technique involving the creation of an end-to-side anastomosis of the rectosigmoid stump to the base of the proximal colonic segment in association with an end colostomy. During a 15-year period, 23 patients were offered this type of surgery. Mortality was zero. Complications were observed in seven patients (morbidity, 7/23). Mean hospitalization time was 12.3 days. Closure of the colostomy was performed approximately 1 month after initial surgery and was easily performed using a mechanical stapler, either intraperitoneally or even extraperitoneally. No complications were observed after closure of the colostomy. The described technique is a useful alternative for the management of selected patients with left-sided colonic surgical emergencies. Its main advantage is that it greatly facilitates colostomy closure, which is performed earlier compared with the colostomy closure after a typical Hartmann's procedure.
左半结肠外科急症的处理通常需要切除带有病变的结肠段、行结肠造口术并封闭直肠乙状结肠残端。封闭造口在技术上可能具有挑战性。在本研究中，我们采用了一种新的手术技术，即将直肠乙状结肠残端与近端结肠段基部进行端侧吻合，并结合结肠造口术。在15年期间，23例患者接受了此类手术。死亡率为零。7例患者出现并发症（发病率为7/23）。平均住院时间为12.3天。结肠造口关闭在初次手术后约1个月进行，使用机械吻合器经腹腔甚至经腹膜外均可轻松完成。结肠造口关闭后未观察到并发症。所描述的技术是处理部分左侧结肠外科急症患者的一种有用的替代方法。其主要优点是极大地便于结肠造口关闭，与典型Hartmann手术术后的结肠造口关闭相比，可更早进行。
