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Surgery of the Large Bowel for Emergent Conditions Staged vs Primary Resection

Charles K. McSherry, MD; William R. Grafe Jr, MD; Herbert S. Perry, MD; Frank Glenn, MD
Arch Surg. 1969;98(6):749-753. doi:10.1001/archsurg.1969.01340120097015.
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"Even were it desirable, it certainly is not possible completely to standardize the treatment of any disease." Cheever

For 75 years surgeons have engaged in an ongoing debate over the choice of operation in patients with disease of the large bowel. The focal point of dispute at the present time concerns the management of patients with emergent conditions of the colon and rectum. There is general agreement that primary resection and end-to-end anastomosis can and should be performed in most patients with perforative and obstructive disease in the ascending and proximal transverse colon. A similar concensus is lacking with respect to identical conditions present in that segment of the large bowel distal to the transverse colon.

In 1931, Cheever1 reported the experience at the Peter Bent Brigham Hospital with carcinoma of the colon and stated, "a general principle so widely accepted that it needs no support is that of


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