Total colectomy: Options in management of acute obstruction of the left-side colon

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Emergency colorectal surgery has been associated with a high morbidity and mortality rate. The current trend for the management of obstruction of left-sided colorectal carcinoma favours primary resection and anastomosis, as a safe and acceptable approach to selected patients. Retrospective review of 81 patients (46 male and 35 female, mean 64 years). Morbidity after emergency total colectomy was 21%, and mortality was 6%. There were 6 anastomotic complications (2 anastomotic disruptions and 4 anastomotic leaks). Mean hospital stay was 13 days. 82% patients had adequate continence. Traditional approach for left-sided colon obstruction is three-stage procedure (Bloch-Paul-Mikulicz). The idea of removing dilated colon proximal to an obstructing tumor is not new, since Lane suggested this option in 1914. In 1965 Hughes and Cuthberson described their experience with 12 patients. At the moment of laparotomy 20% patients had advanced malignant disease. The cumulative morbidity and mortality are high in three-stage procedure. Three-stage approach is associated with high permanent colostomy rate. One-stage resection with primary anastomosis of the obstructed left-sided colon is a safe alternative to staged procedures. Emergency radical resection can be safely performed in majority of patients with left-colon obstruction. Total colectomy with anastomosis is a suitable procedure for treating left-sided colonic obstruction provided that pelvic floor is adequate. Total colectomy has low mortality, acceptable morbidity and good quality of life. The success of the surgery depends on the selection of patients.