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Endoscopic Intraoperative Anastomotic Testing May Avoid Early Gastrointestinal Anastomotic Complications. A Prospective Study

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Gastrointestinal anastomotic complications represent serious events; methods to evaluate anastomotic integrity seem to be suboptimal. Since endoscopic intraoperative anastomotic testing allows direct visualization of anastomosis, complication rates may be theoretically reduced by the use of this technique.

Methods

A prospective study involving 118 consecutive oncologic patients undergoing endoscopically tested gastrointestinal stapled anastomoses was carried out. As controls, 148 historical patients without anastomotic testing were used for comparisons.

Results

In the study group, anastomotic testing revealed 16 defects: 11 (9.3%) air leaks and five (4.3%) bleeding anastomoses. All leaks were oversewn and secured. Bleeding anastomoses were managed under direct visualization, and one non-patent anastomosis was redone. Forty-one (15.4%) postoperative anastomotic complications were observed: eight (3%) bleeding anastomoses, seven (2.6%) stenoses, and 26 (9.8%) clinical leaks. No early dehiscence or bleeding occurred if anastomoses were intraoperatively checked, while these complications were significantly more frequent in non-checked anastomoses (6.1% and 5.4%, respectively). Conversely, late leak and stenosis rates were similar between the two groups.

Conclusion

Endoscopic anastomotic testing was a safe and reliable method to assess integrity of gastrointestinal anastomoses, to correct any defect under direct visualization, and to avoid early complications. However, this method seemed inadequate to predict late anastomotic complications.

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References

  1. Hyman N, Manchester TL, Osler T, Burns B, Cataldo PA. Anastomotic leaks after intestinal anastomosis. It’s later than you think. Ann Surg 2007;245:254–258.

    Article  PubMed  Google Scholar 

  2. Ishihara S, Watanabe T, Nagawa H. Intraoperative colonoscopy for stapled anastomosis in colorectal surgery. Surg Today 2008;38:1063–1065.

    Article  PubMed  Google Scholar 

  3. Ricciardi R, Roberts PL, Marcello PW, Hall JF, Read TE, Schoetz DJ. Anastomotic leak testing after colorectal resection. What are the data? Arch Surg 2009;144:407–411.

    Article  PubMed  Google Scholar 

  4. Kube R, Mroczkowski P, Granowski D, Benedix F, Sahm M, Schmidt U, Gastinger I, Lippert H. Anastomotic leakage after colon cancer surgery: a predictor of significant morbidity and hospital mortality, and diminished tumour-free survival. Eur J Surg Oncol 2010;36:120–124.

    PubMed  CAS  Google Scholar 

  5. Platell C, Hall J. Mechanical bowel preparation before colorectal surgery? Lancet 2007;370:2073–2075.

    Article  PubMed  Google Scholar 

  6. Lazorthes F, Chiotassol P. Stapled colorectal anastomoses: preoperative integrity of the anastomosis and risk of postoperative leakage. Int J Colorectal Dis 1986;1:96–98.

    Article  PubMed  CAS  Google Scholar 

  7. Davies AH, Bartolo DC, Richards AE, Johnson CD, Mac Mortensen NJ. Intraoperative air testing: an audit on rectal anastomosis. Ann R Coll Surg Engl 1988;70:345–347.

    PubMed  CAS  Google Scholar 

  8. Griffith CD, Hardcastle JD. Intraoperative testing of anastomotic integrity after stapled anterior resection for cancer. J R Coll Surg Edinb 1990;35:106–108.

    PubMed  CAS  Google Scholar 

  9. Gilbert JM, Trapnell JE. Intraoperative testing of the integrity of left-sided colorectal anastomoses: a technique of value to the surgeon in training. Ann R Coll Surg Engl 1988;70:158–160.

    PubMed  CAS  Google Scholar 

  10. Dixon AR, Holmes JT. Colorectal anastomotic integrity after anterior resection: is there a role for intraoperative testing? J R Coll Surg Edinb 1991;36:35–36.

    PubMed  CAS  Google Scholar 

  11. Wheeler JM, Gilbert JM. Controlled intraoperative water testing of left-sided colorectal anastomoses: are ileostomies avoidable? Ann R Coll Surg Engl 1999;81:105–108.

    PubMed  CAS  Google Scholar 

  12. Smith S, McGeehin W, Kozol RA, Giles D. The efficacy of intraoperative methylene blue enemas to assess the integrity of a colonic anastomosis. BMC Surg 2007;1:15–20.

    Article  Google Scholar 

  13. Li VK, Wexner SD, Pulido N, Wang H, Jin HY, Weiss EG, Nogeuras JJ, Sands DR. Use of routine intraoperative endoscopy in elective laparoscopic colorectal surgery: can it further avoid anastomotic failure? Surg Endosc 2009;23:2459–2465.

    Article  PubMed  Google Scholar 

  14. Beard JD, Nicholson ML, Sayers RD, Lloyd D, Everson NW. Intraoperative air testing of colorectal anastomoses: a prospective, randomized trial. Br J Surg 1990;77:1095–1097.

    Article  PubMed  CAS  Google Scholar 

  15. Sakanoue Y, Nakao K, Shoji Y, Yanagi H, Kusunoki M, Utsunomiya J. Intraoperative colonoscopy. Surg Endosc 1993;7:84–87.

    Article  PubMed  CAS  Google Scholar 

  16. Carr ND. Intraoperative testing of the integrity of left-sided colorectal anastomoses: a technique of value to the surgeon in training [letter]. Ann R Coll Surg Engl 1988;70:397.

    PubMed  CAS  Google Scholar 

  17. Bruce J, Krukowski ZH, Al-Khairy G, Russel EM, Park KG. Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg 2001;88:1157–1168.

    Article  PubMed  CAS  Google Scholar 

  18. Frossard JL, Gervaz P, Huber O. Water-immersion sigmoidoscopy to treat acute GI bleeding in the perioperative period after surgical colorectal anastomosis. Gastrointest Endosc 2010;71:167–170.

    Article  PubMed  Google Scholar 

  19. Schmidt O, Merkel S, Hohenberger W. Anastomotic leakage after low rectal stapler anastomosis: significance of intraoperative anastomotic testing. Eur J Surg Oncol 2003;29:239–243.

    Article  PubMed  CAS  Google Scholar 

  20. Longo WE. Anastomotic leak testing after colorectal resection. What are the data? [invited critique]. Arch Surg 2009;144:411–412.

    Article  Google Scholar 

  21. den Dulk M, Marijnen CAM, Collette L, Putter H, Pahlman L, Folkesson J, Bosset JF, Rödel C, Bujko K, van de Velde CJ. Multicentre analysis of oncological and survival outcomes following anastomotic leakage after rectal cancer surgery. Br J Surg 2009;96:1066–1075.

    Article  Google Scholar 

  22. Tsikitis VL, Larson DW, Poola VP, Nelson H, Wolff BG, Pemberton JH, Cima RR. Postoperative morbidity with diversion after low anterior resection in the era of neoadjuvant therapy: a single institution experience. J Am Coll Surg 2009;209:114–118.

    Article  PubMed  Google Scholar 

  23. Damrauer SM, Bordeianou L, Berger D. Contained anastomotic leaks after colorectal surgery. Are we too slow to act? Arch Surg 2009;144:333–338.

    Article  PubMed  Google Scholar 

  24. Linn TY, Moran BJ, Cecil TD. Staple line haemorrhage following laparoscopic left-sided colorectal resections may be more common when the inferior mesenteric artery is preserved. Tech Coloproctol 2008;12:289–293.

    Article  PubMed  CAS  Google Scholar 

  25. Marra F, Steffen T, Kalak N, Warschkow R, Tarantino I, Lange J, Zünd M. Anastomotic leakage as a risk factor for the long-term outcome after curative resection of colon cancer. Eur J Surg Oncol 2009;35:1060–1064.

    PubMed  CAS  Google Scholar 

  26. Kirchhoff P, Dincler S, Buchmann P. A multivariate analysis of potential risk factors for intra- and postoperative complications in 1,316 elective laparoscopic colorectal procedures. Ann Surg 2008;248:259–265.

    Article  PubMed  Google Scholar 

  27. Lustosa SA, Matos D, Atallah AN, Castro AA. Stapled versus handsewn methods for colorectal anastomosis surgery. Cochrane Database Syst Rev 2001;3:CD003144.

    PubMed  Google Scholar 

  28. Nishikawa K, Yanaga K, Kashiwagi H, Hanyuu N, Iwabuchi S. Significance of intraoperative endoscopy in total gastrectomy for gastric cancer. Surg Endosc. doi:10.1007/s00464-010-1007-0.

  29. Komen N, Dijk JW, Lalmahomed Z, Klop K, Hop W, Kleinrensink GJ, Jeekel H, Ruud Schouten W, Lange JF. After-hours colorectal surgery: a risk factor for anastomotic leakage. Int J Colorectal Dis 2009;24:789–795.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Surgical Oncology, “F. Magrassi–A. Lanzara” Department of Clinical and Experimental Medicine and Surgery, Second University of Naples School of Medicine, c/o II Policlinico, Edificio 17, Via Pansini, 5, 80131, Naples, Italy

    Eva Lieto, Paolo Castellano, Margherita Pinto, Anna Zamboli, Carlo Pignatelli & Gennaro Galizia

  2. Division of Medical Oncology, “F. Magrassi–A. Lanzara” Department of Clinical and Experimental Medicine and Surgery, Second University of Naples School of Medicine, Naples, Italy

    Michele Orditura & Ferdinando De Vita

Authors
  1. Eva Lieto
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  2. Michele Orditura
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  3. Paolo Castellano
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  4. Margherita Pinto
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  5. Anna Zamboli
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  6. Ferdinando De Vita
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  7. Carlo Pignatelli
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  8. Gennaro Galizia
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Corresponding author

Correspondence to Gennaro Galizia.

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Lieto, E., Orditura, M., Castellano, P. et al. Endoscopic Intraoperative Anastomotic Testing May Avoid Early Gastrointestinal Anastomotic Complications. A Prospective Study. J Gastrointest Surg 15, 145–152 (2011). https://doi.org/10.1007/s11605-010-1371-z

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  • DOI: https://doi.org/10.1007/s11605-010-1371-z

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