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

作　　者：Hui Yu Tham Wen Hui Lim Sneha Rajiv Jain Cheng Han Mg Snow Yunni Lin Jie Ling Xiao Fung Joon Foo Kar Yong Wong Choon Seng Chong 

机构地区：[1]Department of Surgery,University Surgical Cluster,National University Hospital,Singapore 11759,Singapore [2]Department of Medicine,Yong Loo Lin School of Medicine,National University of Singapore,Singapore 11759,Singapore [3]Department of Colorectal Surgery,Singapore General Hospital,Singapore 169608,Singapore [4]Department of General Surgery,Sengkang Health,Singapore 544886,Singapore [5]Colorectal Surgery Service,Department of General Surgery,Tan Tock Seng Hospital,Singapore 308433,Singapore [6]Division of Colorectal Surgery,University Surgical Cluster,National University Health System,Singapore 119228,Singapore [7]Department of General Surgery,Yong Loo Lin School of Medicine,National University of Singapore,Singapore 119228,Singapore

出　　处：《World Journal of Gastrointestinal Surgery》2021年第4期379-391,共13页世界胃肠外科杂志（英文版）（电子版）

摘　　要：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.

关 键 词：COLON Colonic irrigation Intra-operative colonic lavage ANASTOMOSIS Emergency surgery Colonic neoplasm 

分 类 号：R656.9[医药卫生—外科学]