Abstract
We reviewed patients with left colorectal obstruction or perforation to evaluate the efficacy of primary anastomosis and laparoscopic surgery. From July 2001 to March 2003, 18 patients with left colorectal obstruction or perforation underwent surgery involving 7 emergency operations and 11 semiemergency operations (emergency operations after preoperative decompression). Based on informed consent, 11 underwent primary anastomosis and 7 endocolostomy. No significant difference was seen between anastomosis and colostomy groups in lesion sites or preoperative risk factors, although age was significantly higher in the colostomy group. Two postoperative complications in the anastomosis group involved 1 small intestinal necrosis and 1 anastomotic leak. One wound infection occurred in the colostomy group. Laparoscopic surgery was done in 5 patients who recovered from ileus by preoperative decompression and gave informed consent for laparoscopic surgery. Although conversion to conventional open surgery was necessary in 1 patient, complications due to laparoscopic manipulation were not observed in the laparoscopic group. In conclusion, primary anastomosis is safe and effective in patients with left colorectal obstruction or perforation. When preoperative decompression of the intestine is successful, laparoscopic surgery leads to a minimally invasive strategy.
