Abstract: Objective To observe the efficacy of intraoperative colonic irrigation when acute lesions of the left hemicolectomy occur and a one-stage resection or repair is performed. Methods The data of 28 patients with acute lesions of the left hemicolectomy admitted from May 2006 to the present were reviewed, and intraoperative intestinal lavage was performed in all 28 patients. Results All 28 patients underwent one-stage resection and anastomosis of the colon or perforation repair. There were 8 cases of incisional infection, 8 cases of pulmonary infection, 3 cases of cardiac arrhythmia, and 1 case of intestinal fistula, and none of them died. The average length of stay was 17 days. Conclusion Intraoperative colonic irrigation can effectively perform rapid intestinal preparation, and as long as the indications are correctly grasped and the perioperative management is perfected, the majority of colonic irrigation cases can be treated with comprehensive treatment. As long as the indications are correctly grasped, perioperative management is improved, and comprehensive treatment is performed, it is safe and feasible for most patients with colonic injury and obstructive tumors to undergo emergency one-stage resection and anastomosis or perforation repair of the left hemicolectomy. Keywords Acute lesions of the left hemicolectomy, colonic irrigation, acute lesions of the left hemicolectomy are traditionally treated by second-stage resection and anastomosis, but nowadays, with the improvement of people’s living standard, the demand for quality of life is further improved. Phase I resection anastomosis for acute lesions of the left hemicolectomy has gained the recognition of some colleagues. One-stage resection anastomosis has reduced the extra burden on the patient’s body and economy. Since May 2006, we have been using one-stage resection anastomosis or one-stage perforation repair of the left hemicolectomy for acute lesions of the left hemicolectomy with good results. One of the main intraoperative bowel preparation is most important. The intraoperative colonic irrigation technique is reported as follows. 1. Clinical data There were 28 cases of acute lesions of the left hemicolectomy in this group, 18 men and 10 women, aged 23-72 years. The time from onset to surgery was 0.5 hours to 3 days. Two cases were perforated during colonoscopy, four cases were stab wounds, three cases were sigmoid torsion, and the rest were obstructed by cancer in the left hemicolectomy. Immediately after admission, liver and kidney function, coagulation function, electrocardiogram, chest X-ray, standing abdominal film or CT examination of the whole abdomen were improved. They were given anti-inflammatory treatment (cefadroxil + metronidazole), rehydration, maintenance of water-electrolyte balance, gastrointestinal decompression, and routine central venous line placement. Preoperative preparation was done as well as possible within the limited time available. The patients were informed of the possible surgical methods before the operation and were allowed to choose. 2.Surgical method All patients were under general anesthesia with tracheal intubation, and a median right umbilical incision was routinely used to open the abdomen for exploration and to determine the lesion. If intraoperative if found to be tumor obstruction, the intestinal canal was first cut off 50px from the proximal end of the tumor. Then, the tumor and the distal intestinal canal will be removed together. The proximal mesentery was fully freed and a 75px ID rubber threaded tube was inserted into the proximal colon, which was tied with a No. 7 wire and then the proximal colon clamp was loosened and the intestinal contents were drained down the tube into the dirt bucket. The appendix was removed and a Foley catheter was placed from the root of the appendix. 15 ml of water was pumped into the catheter balloon (reinforced with sutures around the catheter if necessary) to prevent the catheter from dislodging and for flushing. If appendectomy has been performed in the past, a Foley catheter can be placed from the end of the ileum to the colon, and 15 ml of water can be pumped into the catheter balloon (if necessary, sutures can be placed around the catheter to strengthen it) to prevent the catheter from being dislodged. The intestinal tube was irrigated again with 0.05% Androflux. After removal of the catheter, the appendiceal root was disinfected with iodophor and routinely sutured, and the purse-string was treated. In case of ileal opening, the small bowel perforation repair method was routinely treated. After trimming the proximal end of the colonic dissection (because the beginning of the dissection is closer to the tumor and less resection, more can be trimmed at present), a one-stage end-to-end anastomosis of the colon was performed. A paranastomotic drainage tube is left in place and an anal tube is placed (if the anastomosis is not far from the anus, an anal tube can be made of latex tube and the proximal end of the anal tube can be passed through the anastomosis). Postoperatively, the anus is dilated for 3 to 5 days, twice a day. If the anastomotic blood flow is unsatisfactory, a separate fistula can be created above the anastomosis with a molar tube, which is removed after 1 month. Postoperatively, routine antibiotics are used to fight infection for 5 to 7 days. If the intestinal tube is perforated and there is no need to remove the intestinal tube, the perforation should be disinfected with iodophor and then sutured with intermittent full-layer sutures, and an intraoperative enema should be performed in the same way, with another surgeon dilating the tube to facilitate the discharge of intestinal contents from the anus. After the intraoperative enema is completed, the suture of the perforation is re-opened, the marginal contaminated tissue is removed (intraoperative enema tends to contaminate the perforation), and the suture is re-sterilized. A drainage tube was left in place next to the perforation site. 3. Results All 28 patients underwent one-stage resection and anastomosis of the colon or repair of the perforation. Among them, 20 cases were able to recover intestinal function in 48-72 h after surgery, and the rest recovered within 5 days. There were 8 cases of incisional infection, 3 of which required second-stage suturing of the incision, and 5 of which healed after drug exchange or negative pressure suction of the incision. There were 8 cases of pulmonary infection, which improved after sputum, cough and anti-inflammatory treatment, and 3 cases of arrhythmia, which improved after symptomatic and supportive treatment such as myocardial nutrition. One case of intestinal fistula was discharged after 14 days of intravenous high nutrition treatment and confirmed to be cured by imaging. There was no case of death. The average length of stay was 17 days. The questionnaire survey showed that 26 patients accounted for 92.8% of the total number of patients were satisfied with the preoperative effect of treatment, and 2 patients were dissatisfied with the incisional infection requiring prolonged treatment. 4. Discussion Acute lesions of the left hemicolectum are performed in emergency surgery without preoperative bowel preparation and mostly require staged surgery. Because of the variety and number of bacteria in the colon and the poor blood flow compared with the small intestine, postoperative anastomotic leakage is common. However, most patients feel painful and their quality of life is seriously affected by second-stage surgery. With the application of intestinal decompression techniques in surgery and the development of antibiotics and intravenous hyper-nutrition, the idea of one-stage resection and anastomosis of acute lesions of the left hemicolectomy is gradually accepted by clinicians and the treatment of intestinal fistula has become more curable with the support of intravenous hyper-nutrition. There is no difference in postoperative complications and morbidity and mortality rates between one-stage surgery and staged surgery of the colon, as studied in clinical practice. In our hospital study results, 20 of these patients recovered intestinal function from 48 to 72 h after surgery, 8 cases of incisional infection, 5 cases of pulmonary infection, and 1 case of intestinal fistula were cured and discharged after intravenous high nutrition treatment. There was no case of death. It shows that intraoperative irrigation plays a significant role in left hemicolectomy. The advantages of intraoperative irrigation are mainly reflected in the fact that intraoperative irrigation can completely decompress the intestine and effectively remove bacteria, improve intestinal wall blood flow and reduce edema, thus relieving the etiology of bacterial translocation and the source of endotoxin in plasma. It is significant in reducing the postoperative inflammatory response. The vast majority of patients were satisfied with this procedure and avoided second-stage surgery. In our hospital, a certain proportion of patients with incisional infection and pulmonary infection were considered to be older patients, longer intraoperative colonic irrigation time, and sometimes insufficient incisional protection, but these complications do not affect the overall treatment effect. As long as the principle of “the upper colon should be empty, the mouth should be loose, and the lower colon should be open” can achieve very good therapeutic results, the anus must be dilated regularly after surgery to keep the distal anastomosis open, and nutritional support must be provided after surgery. In conclusion, we believe that intraoperative colonic irrigation followed by one-stage anastomosis for acute lesions of the left hemicolectomy can achieve the effect of routine intestinal preparation before non-emergency surgery, and intraoperative irrigation plays a great role in one-stage surgery of the left hemicolectomy, providing good basic conditions for one-stage resection and anastomosis of the left hemicolectomy or one-stage perforation repair.