Is colonic lavage a suitable alternative for left-sided colonic emergencies?

Table 1 Summary of comparative results

Intra-operative colonic anastomosis for left-sided colonic emergencies (dichotomous)
Outcome	Hartmann’s procedure		Manual decompression		Without lavage		Subtotal colectomy
	OR; 95%CI	P value	OR; 95%CI	P value	OR; 95%CI	P value	OR; 95%CI	P value
30-d mortality	0.525; 0.272-1.012	0.054	1.054; 0.245-4.569	0.943	0.625; 0.144-2.711	0.530	0.356; 0.035-3.608;	0.382
Anastomotic leak	-	-	0.585; 0.177-1.937	0.380	0.548; 0.121-2.472	0.434	13.462; 0.704-257.466	0.718
Wound infection	0.755; 0.433-1.314	0.320	1.996; 0.402-9.926	0.398	4.130; 1.112-15.338	0.522	-	-
Paralytic ileus	3.405; 0.791-14.655	0.100	-	-	0.474; 0.121-1.859	0.285	-	-
Intra-abdominal infection	0.434; 0.067-2.814	0.381	0.794; 0.284-2.216	0.659	1.012; 0.116-8.821	0.991	0.266; 0.012-6.133	0.408
Pneumonia	0.473; 0.168-1.332	0.156	-	-	0.445; 0.114-1.737	0.244	0.266; 0.012-6.133	0.408
Wound dehiscence	2.560; 0.219-29.869	0.453	1.042; 0.020-54.629	0.984	0.160; 0.007-3.638	0.250	-	-
Evisceration	0.773; 0.146-4.080	0.761	-	-	4.241; 0.207-86.954	0.348	-	-
Sepsis	0.348; 0.096-1.257	0.107	-	-	-	-	2.300; 0.075-71.005	0.634
Re-operation	0.560; 0.094-3.324	0.523	1.237; 0.366-4.185	0.733	0.184; 0.008-4.407	0.296	-	-
Intra-operative colonic anastomosis for left-sided colonic emergencies (continuous)
Outcome	WMD; 95%CI	P value	WMD; 95%CI	P value	WMD; 95%CI	P value	WMD; 95%CI	P value
Duration of surgery (min)	-4.890; 34.708-24.928	0.748	22.593; -6.364-51.550	0.126	27.553; 10.560-44.546	0.001b	45.000; 25.475-64.525	< 0.001c
Time to carry out intervention (min)	-	-	15.000; 9.746-20.254	< 0.001c	-	-	-	-
Intraoperative blood loss (ml)	93.222; -103.779-290.223	0.354	-	-	-	-	-	-
Duration of hospital stay (days)	-7.750; -13.504- -1.996	0.008b	3.500; 2.943-4.057	< 0.001c	-25.911; -67.404-15.582	0.221	0.300; -6.146-6.746	0.927

^bP < 0.01.

^cP < 0.001.

OR: Odds ratio; WMD: Weighted mean differences.

Table 2 Results of intra-operative colonic lavage only

Outcome	All indications			Cancer only
	Sample size	Incidence	CI	Sample size	Incidence	CI
Intra-operative colonic anastomosis for left-sided colonic emergencies (dichotomous)
30-d mortality	1091	0.04	0.03-0.05	517	0.02	0.01-0.04
Anastomotic leak	1070	0.03	0.02-0.04	485	0.03	0.01-0.05
Wound infection	1018	0.12	0.09-0.16	498	0.11	0.07-0.16
Paralytic ileus	342	0.06	0.03-0.11	143	0.07	0.00-0.18
Intra-abdominal infection	630	0.03	0.01-0.04	249	0.01	0.00-0.03
Pneumonia	444	0.07	0.02-0.15	219	0.05	0.00-0.12
Sepsis	341	0.02	0.01-0.05	131	0.02	0.00-0.05
Re-operation	420	0.05	0.02-0.07	78	0.02	0.00-0.07
Intra-operative colonic anastomosis for left-sided colonic emergencies (continuous)
Duration of surgery (min)	513	194.555	164.834- 224.276	361	189.565	145.293-233.837
Intra-operative Blood loss (mL)	52	290.996	-184.98-766.973	37	104.170	-72.227-280.567
Duration of hospital stay (d)	563	15.935	12.927-18.944	135	15.720	9.233-22.207