Key result
On-table colonic lavage allowed for successful single-stage curative resection and primary anastomosis in 100% of patients (14/14) with impacted fecal matter, with no anastomotic leaks or mortality.
Why the study?
Does on-table colonic lavage using a low-cost indigenous technique allow safe single-stage resection in patients with obstructive left-sided colorectal pathology and impacted fecal matter?
Observational (n=14)
Does on-table colonic lavage using a low-cost indigenous technique allow safe single-stage resection in patients with obstructive left-sided colorectal pathology and impacted fecal matter?
On-table colonic lavage using a low-cost technique is a safe and feasible method to enable single-stage resection in patients with loaded colons, potentially reducing the need for preoperative mechanical bowel preparation.
May support single-stage resection in loaded colons; extends feasibility data but leaves open randomized confirmation.
Background: Preoperative mechanical bowel preparation (MBP) for elective colorectal surgery has been criticized, but is still in use because of fear of fecal load and peritoneal contamination. Experience with an indigenous low cost technique for on-table colonic lavage (OTCL) in obstructive left-sided colonic pathology has been described. OTCL would be a step towards discouraging MBP before colorectal surgery. Patients and Methods: Fourteen patients for elective colorectal surgery without preoperative bowel preparation were evaluated and found with impacted fecal matter and loaded colon intraoperatively. Instead of two-stage procedure, we did OTCL by our own devised method followed by a single-stage curative resection. Results: All patients had successful resection and primary anastomosis of their lesions. Mean time for lavage was 21 min. There was no peritoneal contamination. No postoperative anesthesia or procedure-related complication was encountered. No clinical anastomotic leak or mortality was encountered. In one patient, surgical site wound infection occurred. Conclusion: In cases where bowel preparation is not done preoperatively and single-stage procedure discredited only because of impacted fecal matter, OTCL should be taken into account. Our technique of OTCL should be employed as it is simple, safe, and cheap and would prove to be a step towards discouraging preoperative MBP for elective colorectal surgery, especially in resource limited setting.
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Khan et al. (2014) conducted an observational in Obstructive left-sided colorectal pathology (n=14). On-table colonic lavage (OTCL) was evaluated on Successful resection and primary anastomosis. On-table colonic lavage allowed for successful single-stage curative resection and primary anastomosis in 100% of patients (14/14) with impacted fecal matter, with no anastomotic leaks or mortality.
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