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. 2021 Apr 27;13(4):379-391.
doi: 10.4240/wjgs.v13.i4.379.

Is colonic lavage a suitable alternative for left-sided colonic emergencies?

Hui Yu Tham  1 , Wen Hui Lim  2 , Sneha Rajiv Jain  2 , Cheng Han Mg  2 , Snow Yunni Lin  2 , Jie Ling Xiao  2 , Fung Joon Foo  3 , Kar Yong Wong  4 , Choon Seng Chong  5
Affiliations

Is colonic lavage a suitable alternative for left-sided colonic emergencies?

Hui Yu Tham et al. World J Gastrointest Surg. .

Abstract

Background: The use of intra-operative colonic lavage (IOCL) with primary anastomosis remains controversial in the emergency left-sided large bowel pathologies, with alternatives including Hartmann's procedure, manual decompression and subtotal colectomy.

Aim: To compare the peri-operative outcomes of IOCL to other procedures.

Methods: Electronic databases were searched for articles employing IOCL from inception till July 13, 2020. Odds ratio and weighted mean differences (WMD) were estimated for dichotomous and continuous outcomes respectively. Single-arm meta-analysis was conducted using DerSimonian and Laird random effects.

Results: Of 28 studies were included in this meta-analysis, involving 1142 undergoing IOCL, and 634 other interventions. IOCL leads to comparable rates of wound infection when compared to Hartmann's procedure, and anastomotic leak and wound infection when compared to manual decompression. There was a decreased length of hospital stay (WMD = -7.750; 95%CI: -13.504 to -1.996; P = 0.008) compared to manual decompression and an increased operating time. Single-arm meta-analysis found that overall mortality rates with IOCL was 4% (CI: 0.03-0.05). Rates of anastomotic leak and wound infection were 3% (CI: 0.02-0.04) and 12% (CI: 0.09-0.16) respectively.

Conclusion: IOCL leads to similar rates of post-operative complications compared to other procedures. More extensive studies are needed to assess the outcomes of IOCL for emergency left-sided colonic surgeries.

Keywords: Anastomosis; Colon; Colonic irrigation; Colonic neoplasm; Emergency surgery; Intra-operative colonic lavage.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart.
Figure 2
Figure 2
Meta-analysis of 30-d mortality.
Figure 3
Figure 3
Single-arm meta-analysis of anastomotic leak rates in intra-operative colonic lavage.
Figure 4
Figure 4
Single-arm meta-analysis of wound infection rates in intra-operative colonic lavage.
See this image and copyright information in PMC

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