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A comparative study between primary resection and anastomosis and staged procedure in left colon obstruction

Author: 
Dr. Jamsed Mollah, Dr. Niladri Sarkar, Dr. Debabrata Ray, Dr. Ranjan Bhattacharyya, Dr. Utpal Roy and Dr. Jayanta Pal
Subject Area: 
Health Sciences
Abstract: 

Introduction: The management of left colonic obstruction is a real clinical challenge for surgeons. The resection with on table lavage and anastomosis is the cornerstone of surgical management of large gut obstruction. Methodology: Among the left colonic obstructions, 40 samples included in this non-randomized, longitudinal study in a prospective case series design which satisfy the criteria. Results: Almost 80% cases of acute large gut obstruction occurred between 51 to 80 years of age. It was observed that 10% patients were from higher class, 32.5% from middle class and 57.5% from lower class. The incidence of complication was 28.6% in resection and anastomosis group (4/16) and 66.7% in staged resection group (6/9). All the cases of volvulus in this study had occurred in sigmoid colon, whereas carcinoma had more or less uniform distribution across the left colon. Discussion: The male female ratio of left colonic obstruction in this study was 3:2. The mechanical bowel preparation offer no significant benefit as a preoperative measure in current practice. In spite of risk of spillage and contamination, colonic decompression offers some better result. Conclusion: The left colonic obstruction is a surgical emergency and volvulus principally affects lower socio economic groups. Despite controversies and lack of unanimity in opinion, planned selection of single stage surgery offers better outcome than staged surgical procedures and surgeons should be careful for selecting and planning for these cases.

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