Intraoperative colonoscopy: Is it a better way of detecting leakage after circular stapler anastomosis?

Abstract

© 2018, Medical Association of Thailand. All rights reserved. Background: Surgery for colorectal cancer can significantly improve the survival of patients. Although surgical techniques and equipment have improved over the past 20 years, anastomosis leakage after colorectal cancer surgery continue to be a significant complication. Multiple comorbidities and mortality after colorectal anastomosis leakage have been described for example, increasing the need for a permanent colostomy and increased recurrence rate of cancer. Objective: To evaluate the impact of intraoperative colonoscopy as an intraoperative air leak test in colorectal cancer surgery. Materials and Methods: One new technique in the procedure of colorectal anastomosis is the circular staple autosuture, which decreases the operative time of colorectal surgery. However, there is no standard technique for testing or checking for colorectal anastomosis leakage. Results: Data were collected from 33 patients who had colorectal cancer and underwent tumor resection. Eight patients (24%) underwent surgery using the open technique, 13 patients (39%) by the laparoscopic-assisted technique, and 12 patients (36%) by hand-assisted laparoscopic technique. After the tumor was resected, the proximal and distal end of colon and/or rectum were anastomosed using a circular stapler. Afterwards, the anastomosis leak test was carried out by intraoperative colonoscopy to investigate any leakage of air and/or bleeding from the anastomosis site. The intraoperative colonoscopic findings were compared to the postoperative clinical evidence of possible anastomosis leakage. From the present study, there was no air leakage from the anastomosis by using this technique, which correlated to no evidence of postoperative clinical symptoms of leakage. Conclusion: Detection of anastomosis leakage after circular stapler by intraoperative colonoscopy is an accurate and safe technique for the detection of leakage and bleeding.