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International Journal of Colorectal Disease

, Volume 31, Issue 8, pp 1431–1436 | Cite as

Management of postoperative bleeding after laparoscopic left colectomy

  • Romain Besson
  • Christos Christidis
  • Christine Denet
  • Laurence Bruyns
  • Hugues Levard
  • Brice Gayet
  • David Fuks
  • Thierry Perniceni
Original Article

Abstract

Background

Lower gastrointestinal bleeding after left colectomy is an uncommon complication that can lead to critical situation. Diagnostic and therapeutic manoeuvres should be performed in emergency with step-by-step strategy in order to avoid reoperation. This study aims to identify bleeding risks factors and describe a management strategy.

Methods

This is a retrospective study of patients who underwent left colectomy with primary anastomosis, from May 2004 to December 2013. We studied their demographic characteristics, surgical procedures and postoperative courses, more specifically hemorrhagic complications, management of bleeding and outcomes.

Results

Hemorrhagic anastomotic complication occurred in 47 of the 729 (6.4 %) patients after left colectomy. Neither anticoagulant nor antiaggregant treatment was associated with postoperative bleeding. Among the 47 patients with bleeding, endoscopy was performed in 37 (78.7 %). At the time of endoscopy, the bleeding was spontaneously stopped in nine (24.3 %). Therapeutic strategy used clips in 10 (27.0 %) cases, mucosal sclerosis in 11 (29.7 %) and both in 7 (18.9 %) cases. Four (8.5 %) patients required blood transfusion for treatment of this gastrointestinal bleeding. Five (10.6 %) patients with bleeding were reoperated in this group because early endoscopy showed associated anastomotic leakage. Based on a multivariate analysis, stapled anastomosis and diverticular disease were independent factors associated with anastomotic bleeding.

Conclusions

Postoperative anastomotic bleeding is not so uncommon after left colectomy. This complication should be particularly dreaded in patients who underwent stapled colorectal anastomosis for diverticular disease. With the use of clip or mucosal sclerosis, early endoscopy is a safe and efficient treatment.

Keywords

Laparoscopic left colectomy Anastomotic bleeding Colonoscopy Haemostasis 

Notes

Author contributions

Romain Besson: acquisition of data, conception and design, drafting the article, approval of the version to be published

Christos Christidis: acquisition of data, approval of the version to be published

Christine Denet: acquisition of data, approval of the version to be published

Laurence Bruyns: acquisition of data, approval of the version to be published

Hugues Levard: acquisition of data, approval of the version to be published

Brice Gayet: revising the article, approval of the version to be published

David Fuks: conception and design, analysis and interpretation of data, drafting the article, approval of the version to be published

Thierry Perniceni: revising the article, approval of the version to be published

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Romain Besson
    • 1
  • Christos Christidis
    • 1
  • Christine Denet
    • 1
  • Laurence Bruyns
    • 1
  • Hugues Levard
    • 1
  • Brice Gayet
    • 1
    • 2
  • David Fuks
    • 1
    • 2
  • Thierry Perniceni
    • 1
  1. 1.Department of Digestive DiseaseInstitut Mutualiste MontsourisParisFrance
  2. 2.Université Paris DescartesParisFrance

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