Aim: To approach the best surgical procedure to manage obstructing carcinoma of the left colon.
Methods: A total of 75 patients with obstructing left colonic carcinoma were equally randomized into three 
groups, 25 patients each. Group I underwent Hartmann's procedure, group II underwent primary resection 
anastomosis with covering ileostomy, while group III underwent primary resection anastomosis after on-table 
colonic lavage. The results of the three procedures were recorded and compared regarding the operative time, 
operative blood loss, the post-operative morbidity and mortality, intestinal leakage, psychological drawbacks, 
the hospital stay and the delay in starting the course of chemotherapy.
Results: There was no significant difference in the incidence of postoperative morbidity and mortality among 
the three groups but there is highly significant decrease in the incidence of nutritional deficiencies & 
psychological troubles and in the total hospital stay and time delay before receiving the 
chemotherapy in group III in comparison to group I & II. There was similar risk of anastomotic leakage in the 
three groups
Conclusion: Primary resection anastomosis after on-table colonic lavage appears to be the most ideal 
procedure as it provides a single stage final solution of the problem without increased risk of leakage or other 
complications and with the least psychological impact on the patient.