Primary Anastomosis with Intraoperative Colonic Irrigation in generalized peritonitis due to Left colon cancer obstruction

Jin Woo Jung, MD, Jae Hwang Kim, MD, PhD, Sang Hun Jung, MD, PhD, So Hyun Kim, MD, PhD, Ji Yong Lim, MD, Mu Jung Roh. YeungNam University Medical Center.

Introduction : In general, Hartmann’s procedure(HP) is considered as a treatment of choice in generalized peritonitis due to left-side colon cancer obstruction with perforation.The aim of this study was to evaluate the short term outcome of primary anastomosiswith intraoperative colonic irrigation(IACI) in the same setting as peritonitis.

Methods and procedures : Prospectively collected data of peritonitis patient with colon cancer obstruction between January 2001 and March 2013 in a single institute were evaluated. Fifty-nine patients who underwent IACI and HP were included in the study.

Results: Of 59 patients, 32 and 27 patients underwent IACI and HP respectively. There were no significant differences between patients’ characteristics between the groups. Purulent peritonitis occurred 8(25.8%) in IACI and 7 (25.0%) in HP (P=0.943). There were no significant difference between groups in postoperative mortality and morbidity; Postoperative mortality was 5 of 32(15.6%)in IACIand 4 of 27(14.8%) in HP, morbidity(postop ARF/sepsis) was 6/14 in IACI and 7/12 in HP. Postoperative anastomotic leakage was noted in two(15.5%) IACI patients. Permanent stoma rate was 6(18.8%) in IACI and 14(51.9%) in HP. (P=0.007)

Conclusion: Primary anastomosis with intraoperative irrigation can be safely performed and reduce permanent stoma in left colon cancer obstruction with peritonitis in comparison with Hartmann’s procedure.

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