The Usefulness of Intraoperative Colonic Irrigation and Primary Anastomosis in Patients Requiring a Left Colon Resection

PURPOSE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.

The Economic Efficiency of the Single Stage Management of Left Colon Cancer Patient

PURPOSE: Two-stage management with Hartmann's procedure is the most common procedure used for the treatment of obstructive left colon cancer with or without perforation. However, single-stage procedures have gained popularity recently with reports that show little difference in safety compared to the conventional multi-stage procedures. To evaluate the economic advantage of single stage procedure compare with two stage procedure in emergent left colonic pathology. METHODS: Eleven patients (SP; single stage procedure) without other accompanying diseases among 15 patients who entered the emergency room and treated by the single stage procedure using the intraoperative irrigation for the left colon obstructions with or without perforation during the period from July of 1999 to November of 2000, were compared in their costs retrospectively with 11 patients (MP; multiple stage procedure) without other accompanying diseases and had final reduction of stoma out of 28 patients treated by Hartman's procedures including the resections of lesions during the period from September 1996 to May 1999 with the same diagnosis. The costs were compared using Mann-Whitney U tests, with data on the costs of overall treatments, operations, anesthesia, admission room, medications, test/evaluations, and managements as well as days of hospital stay, all on the record of accounting department. The relationships of the factors to the total cost of treatment were evaluated using Multi-variant regression analysis, and the pre-operative physiologic status were compared using APACHE III scoring system. The total treatment cost did not include optional treatment costs, uninsured admission room costs, and the costs of colonic irrigator used in the operations for the SP. RESULTS: There were no significant difference in the age and gender of the two groups as 67 +/-15 years with 6 males for the SP and 6+/-19 years with 7 males for the MP. The preoperative physiologic status of patients, in APACHE III scoring system, were 29.1+/-10.6 in the SP and 26.1+/-8.2 in the MP without any significant difference between the two groups. The average of hospital stay showed a significant difference between two groups as 17.1+/-6.2 (range: 13-25) days for the SP and 31.3 (range: 24-43) days for the MP (p<0.01). The average of total costs showed also a significant difference in two groups as 3,938 687 (range: 3,017-4,974) thousand won for the SP and 7,543 1,851 (range: 5,314-9925) thousand won for the MP (p<0.01). It showed that the SP had roughly 50, 53, 76, 79, and 72% reductions of costs over operations, anesthesia, admission room, medications, tests/evaluations, and managements. The analysis of the overall costs of treatments showed 3,540 thousand won reduction in SP. CONCLUSIONS: Single stage procedure using intraoperative colonic irrigation technique showed no difference in safety but has an economical advantage over the conventional multiple stage in the management of emergent left colonic obstruction or perforation patients.