OBSTRUCTING LEFT COLONIC CARCINOMA: THE SURGICAL CHALLENGE

Document Type : Original Article

Authors

Department of General Surgery and Psychiatry, Faculty of Medicine, Zagazig University, Egypt

Abstract

Aim: To approach the best surgical procedure to manage obstructing carcinoma of the left colon.
Methods: A total of 75 patients with obstructing left colonic carcinoma were equally randomized into three 
groups, 25 patients each. Group I underwent Hartmann's procedure, group II underwent primary resection 
anastomosis with covering ileostomy, while group III underwent primary resection anastomosis after on-table 
colonic lavage. The results of the three procedures were recorded and compared regarding the operative time, 
operative blood loss, the post-operative morbidity and mortality, intestinal leakage, psychological drawbacks, 
the hospital stay and the delay in starting the course of chemotherapy.
Results: There was no significant difference in the incidence of postoperative morbidity and mortality among 
the three groups but there is highly significant decrease in the incidence of nutritional deficiencies & 
psychological troubles and in the total hospital stay and time delay before receiving the 
chemotherapy in group III in comparison to group I & II. There was similar risk of anastomotic leakage in the 
three groups
Conclusion: Primary resection anastomosis after on-table colonic lavage appears to be the most ideal 
procedure as it provides a single stage final solution of the problem without increased risk of leakage or other 
complications and with the least psychological impact on the patient.

Keywords

The Egyptian Journal of Surgery
Volume 32, Issue 4
October 2013
Pages 266-273

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