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

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 ileorectal 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. Copyright (C) 2001 S. Karger AG, Basel.