Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2021; 13(4): 379-391
Published online Apr 27, 2021. doi: 10.4240/wjgs.v13.i4.379
Is colonic lavage a suitable alternative for left-sided colonic emergencies?
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
Hui Yu Tham, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore 11759, Singapore
Wen Hui Lim, Sneha Rajiv Jain, Cheng Han Mg, Snow Yunni Lin, Jie Ling Xiao, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 11759, Singapore
Fung Joon Foo, Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore
Fung Joon Foo, Department of General Surgery, Sengkang Health, Singapore 544886, Singapore
Kar Yong Wong, Colorectal Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
Choon Seng Chong, Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore 119228, Singapore
Choon Seng Chong, Department of General Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
Author contributions: Study conception and design was conducted by Jain SR, Mg CH and Chong CS; material preparation, data collection, analysis and interpretation were performed by Tham HY, Lim WH, Jain SR, Mg CH and Lin SY; the first draft was written by Tham HY, Lim WH, Jain SR and Mg CH; all authors commented on previous versions of the manuscript, read and approved the final manuscript.
Conflict-of-interest statement: The authors declare no conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Choon Seng Chong, FRCS (Ed), MBBS, Assistant Professor, Division of Colorectal Surgery, University Surgical Cluster, National University Health System, 1E Kent Ridge Road, Singapore 119228, Singapore. choon_seng_chong@nuhs.edu.sg
Received: November 16, 2020
Peer-review started: November 16, 2020
First decision: February 14, 2021
Revised: February 16, 2021
Accepted: March 12, 2021
Article in press: March 12, 2021
Published online: April 27, 2021
Processing time: 155 Days and 7.2 Hours
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: Colon; Colonic irrigation; Intra-operative colonic lavage; Anastomosis; Emergency surgery; Colonic neoplasm

Core Tip: Comparing the intra and post-operative outcomes of primary resection and immediate reconstruction after either intra-operative colonic lavage (IOCL), manual decompression or without IOCL against Hartmann’s procedure and subtotal colectomy in the management of colorectal emergencies, intraoperative colonic lavage was found to have largely similar rates of post-operative complications compared to other procedures. The operative duration was observed to be statistically longer in IOCL than without IOCL. However, hospitalization stay was significantly shorter in duration in those with IOCL compared to Hartmann’s. Thus, there may be merits in choosing IOCL especially for patients who are hemodynamically stable.