Hong Youngki, Nam Soomin, Kang Jung Gu
Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
Ann Coloproctol. 2017 Jun;33(3):106-111. doi: 10.3393/ac.2017.33.3.106. Epub 2017 Jun 30.
The aim of this study is to assess the short-term outcome of intraoperative colonic irrigation and primary anastomosis and to suggest the usefulness of the procedure when a preoperative mechanical bowel preparation is inappropriate.
This retrospective study included 38 consecutive patients (19 male patients) who underwent intraoperative colonic irrigation and primary anastomosis for left colon disease between January 2010 and December 2016. The medical records of the patients were reviewed to evaluate the patients' characteristics, operative data, and postoperative short-term outcomes.
Twenty-nine patients had colorectal cancer, 7 patients had perforated diverticulitis, and the remaining 2 patients included 1 with sigmoid volvulus and 1 with a perforated colon due to focal colonic ischemia. A diverting loop ileostomy was created in 4 patients who underwent a low anterior resection. Complications occurred in 15 patients (39.5%), and the majority was superficial surgical site infections (18.4%). Anastomotic leakage occurred in one patient (2.6%) who underwent an anterior resection due sigmoid colon cancer with obstruction. No significant difference in overall postoperative complications and superficial surgical site infections between patients with obstruction and those with peritonitis were noted. No mortality occurred during the first 30 postoperative days. The median hospital stay after surgery was 15 days (range, 8-39 days).
Intraoperative colonic irrigation and primary anastomosis seem safe and feasible in selected patients. This procedure may reduce the burden of colostomy in patients requiring a left colon resection with an inappropriate preoperative mechanical bowel preparation.
本研究旨在评估术中结肠灌洗及一期吻合术的短期疗效，并探讨在术前机械性肠道准备不适用时该手术方法的实用性。
这项回顾性研究纳入了2010年1月至2016年12月期间连续38例（19例男性患者）因左半结肠疾病接受术中结肠灌洗及一期吻合术的患者。回顾患者的病历以评估患者特征、手术数据及术后短期疗效。
29例患者患有结直肠癌，7例患者患有穿孔性憩室炎，其余2例患者中1例为乙状结肠扭转，1例为局灶性结肠缺血导致的结肠穿孔。4例行低位前切除术的患者进行了转流性回肠造口术。15例患者（39.5%）发生并发症，多数为表浅手术部位感染（18.4%）。1例因乙状结肠癌伴梗阻行前切除术的患者发生吻合口漏（2.6%）。梗阻患者与腹膜炎患者在总体术后并发症及表浅手术部位感染方面未发现显著差异。术后30天内无死亡病例。术后中位住院时间为15天（范围8 - 39天）。
术中结肠灌洗及一期吻合术在特定患者中似乎是安全可行的。该手术方法可能会减轻术前机械性肠道准备不适用的左半结肠切除术患者的结肠造口负担。
