Interposition of a jejunal segment as an alternative one-stage operation for acute left colon obstruction

Dan D. Hershko, Bishara Bishara, James H. Paxton, Bruce Robb, Curtis J. Wray, Arie Eitan

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose. Much debate surrounds the one-stage surgical management of acute left colon obstruction. Many surgeons are still reluctant to perform primary anastomosis in unprepared bowel fearing the risk of anastomotic dehiscence. Although intraoperative lavage and subtotal colectomy have recently proved effective for preventing fecal loading, both of these procedures have drawbacks and the search for additional alternative surgical procedures continues. We conducted an experimental study to examine a new one-stage operation, consisting of the interposition of a jejunal segment to the resection site of the colon, to manage acute left colon obstruction. Methods. The colons of 20 domestic pigs were obstructed, and 2 days later, segmental resection and either primary colo-colonic anastomosis or interposition of a jejunal segment was performed. Autopsies were done 6 weeks after the operations and the anastomotic regions were subjected to bursting pressure analysis. Results. The operating time was longer in the interposition group at 49 ± 14 vs 38 ± 12min (P <0.01). There was no mortality or clinical signs of anastomotic dehiscence in either group. A perianastomotic abscess was detected on autopsy in one animal from the primary colo-colonic anastomosis group. The bursting pressures of the jejunocolic anastomoses were significantly higher (P <0.001) than those of the primary colo-colonic anastomoses. Conclusions. These experimental results suggest that jejunal interposition may be a feasible alternative to primary colonic anastomosis to create intestinal continuity after resection for acute obstruction of the left colon.

Original languageEnglish (US)
Pages (from-to)804-808
Number of pages5
JournalSurgery Today
Volume32
Issue number9
DOIs
StatePublished - 2002
Externally publishedYes

Fingerprint

Colon
Autopsy
Pressure
Sus scrofa
Colectomy
Therapeutic Irrigation
Abscess
Mortality

Keywords

  • Anastomosis
  • Interposition
  • Jejunum
  • Left colon obstruction
  • Primary resection

ASJC Scopus subject areas

  • Surgery

Cite this

Interposition of a jejunal segment as an alternative one-stage operation for acute left colon obstruction. / Hershko, Dan D.; Bishara, Bishara; Paxton, James H.; Robb, Bruce; Wray, Curtis J.; Eitan, Arie.

In: Surgery Today, Vol. 32, No. 9, 2002, p. 804-808.

Research output: Contribution to journalArticle

Hershko, Dan D. ; Bishara, Bishara ; Paxton, James H. ; Robb, Bruce ; Wray, Curtis J. ; Eitan, Arie. / Interposition of a jejunal segment as an alternative one-stage operation for acute left colon obstruction. In: Surgery Today. 2002 ; Vol. 32, No. 9. pp. 804-808.
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