Current practices in left-sided colonic emergencies: A survey of US gastrointestinal surgeons

Ajay Goyal, Moshe Schein

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Background: The paradigms in the surgical management of obstruction and perforation of the left colon - once considered absolute contraindications to primary resection and anastomosis - are changing. The aim of this survey was to poll American Gastrointestinal surgeons on their current approach to left colonic emergencies. Methods: A questionnaire was sent to 500 US-based surgeons, randomly selected members from the membership list of the Society for Surgery of the Alimentary Tract. It surveyed the surgeons on how they would approach 'good-risk' and 'poor-risk' patients with left colonic obstruction or perforation. Results: 215 (43%) surgeons responded to the questionnaire; 180 fully completed questionnaires (36%) were analyzed. Sigmoid obstruction: 96 responders (53%) selected a one-stage procedure in 'good-risk' patients; 78 preferred sigmoid resection with (n =46) or without (n =32) 'on-table' colonic lavage and 18 opted for a subtotal colectomy and ileo-rectal anastomosis. Most (94%) responders preferred a staged procedure in 'high-risk' patients: a Hartmann resection (n =120) or a transverse colostomy (n =46). Sigmoid diverticular perforation: only one third of the responders recommended a one-stage procedure in 'good-risk' patients: 58 would perform a sigmoidectomy with (n =19) or without (n =39) 'on-table' colonic lavage; only two opted for subtotal colectomy with ileo-rectal anastomosis. In 'high-risk' patients most surgeons opted for a Hartmann's (88%) procedure or a diverting colostomy (7%). Conclusions: This survey suggests that a half and one-third of the responders would perform a one-stage resection and anastomosis in 'good-risk' patients with left colonic obstruction and perforation, respectively. In 'poor-risk' patients most responders would still opt for a staged procedure.

Original languageEnglish (US)
Pages (from-to)399-402
Number of pages4
JournalDigestive Surgery
Volume18
Issue number5
DOIs
StatePublished - Dec 24 2001
Externally publishedYes

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Emergencies
Sigmoid Colon
Colostomy
Colectomy
Therapeutic Irrigation
Surveys and Questionnaires
Surgeons
Colon

All Science Journal Classification (ASJC) codes

  • Surgery
  • Gastroenterology

Cite this

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title = "Current practices in left-sided colonic emergencies: A survey of US gastrointestinal surgeons",
abstract = "Background: The paradigms in the surgical management of obstruction and perforation of the left colon - once considered absolute contraindications to primary resection and anastomosis - are changing. The aim of this survey was to poll American Gastrointestinal surgeons on their current approach to left colonic emergencies. Methods: A questionnaire was sent to 500 US-based surgeons, randomly selected members from the membership list of the Society for Surgery of the Alimentary Tract. It surveyed the surgeons on how they would approach 'good-risk' and 'poor-risk' patients with left colonic obstruction or perforation. Results: 215 (43{\%}) surgeons responded to the questionnaire; 180 fully completed questionnaires (36{\%}) were analyzed. Sigmoid obstruction: 96 responders (53{\%}) selected a one-stage procedure in 'good-risk' patients; 78 preferred sigmoid resection with (n =46) or without (n =32) 'on-table' colonic lavage and 18 opted for a subtotal colectomy and ileo-rectal anastomosis. Most (94{\%}) responders preferred a staged procedure in 'high-risk' patients: a Hartmann resection (n =120) or a transverse colostomy (n =46). Sigmoid diverticular perforation: only one third of the responders recommended a one-stage procedure in 'good-risk' patients: 58 would perform a sigmoidectomy with (n =19) or without (n =39) 'on-table' colonic lavage; only two opted for subtotal colectomy with ileo-rectal anastomosis. In 'high-risk' patients most surgeons opted for a Hartmann's (88{\%}) procedure or a diverting colostomy (7{\%}). Conclusions: This survey suggests that a half and one-third of the responders would perform a one-stage resection and anastomosis in 'good-risk' patients with left colonic obstruction and perforation, respectively. In 'poor-risk' patients most responders would still opt for a staged procedure.",
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Current practices in left-sided colonic emergencies : A survey of US gastrointestinal surgeons. / Goyal, Ajay; Schein, Moshe.

In: Digestive Surgery, Vol. 18, No. 5, 24.12.2001, p. 399-402.

Research output: Contribution to journalArticle

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