In-sleeve on-table colonic irrigation in telescopic fashion and intraoperative colonoscopy: a novel technique.

BACKGROUND In the management of large bowel obstruction, on-table lavage and intraoperative colonoscopy allow a safe resection and primary anastomosis in selected patients. Previous techniques carry serious disadvantages, in the form of inconvenient drainage route and spillage. A novel technique of in-sleeve on-table colonic lavage using a camera sleeve is described. METHODS Six patients (58-80 years old, median 73) who admitted to emergency service between 2003 and 2009 with colonic obstruction due to tumor underwent colonic resection and primary anastomosis after on-table lavage. The colon was divided proximally to the obstruction, and then was introduced into a nylon sleeve and sutured. A Foley catheter was inserted to the cecum for irrigation. After irrigation, intraoperative colonoscopy was accomplished. RESULTS The technique was successfully used in all patients. The colonic irrigation took 12-16 minutes and colonoscopy was completed in 7-20 minutes. There was no contamination during the washout of the colon. Four patients underwent left hemicolectomy; extended right hemicolectomy and total colectomy was performed in the remaining two. There were no complications in the postoperative period. CONCLUSION The described technique of in-sleeve on-table lavage is safe and quick to washout the fecal load in the obstructed colon. It prevents the contamination risk and shortens the operative period for resection and primary anastomosis. This method also enables an effective intraoperative colonoscopy.