On-Table Lavage

Indications
Packed obstructed colon in need of an anastomosis.

Special Preparation
1. Anaesthetic tubing
2. Umbilical tape
3. Two heavy plastic bags in a bucket with a tie to put around the top
4. Rectal catheter
5. Cystoscopy flushing set
6. 3L+ of water

Prep
N/A

Procedure
1. Big laparotomy wound, mobilize the splenic flexure
- need to be able to palpate / manipulate whole colon.
2. Resect.
3. Tie anaesthetic tubing on to distal bowel end with 2 serial umbilical tapes (clamp proximally)
- this bit of bowel gets damaged and should be accounted for in the planned further resection.
- connect other end into the plastic bags
4. Insert rectal catheter through ileostomy site or appendiceal stump.
- purse string.
5. Connect flushing set and wash the bowel.

Alternatives and Controversies
In critically compromised or highly comorbid patients, consider damage control principles
A stoma is faster and gives better damage control.
But 50% of Hartman's are not reversed.