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Management of postoperative bleeding after laparoscopic left colectomy

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International Journal of Colorectal Disease Aims and scope Submit manuscript

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.

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References

  1. Piessen G, Muscari F, Rivkine E et al (2011) Prevalence of and risk factors for morbidity after elective left colectomy: cancer vs noncomplicated diverticular disease. Arch Surg 1960(146):1149–1155

    Article  Google Scholar 

  2. Neutzling CB, Lustosa SAS, Proenca IM, da Silva EMK, Matos D (2012) Stapled versus handsewn methods for colorectal anastomosis surgery. Cochrane Database Syst Rev 2, CD003144

    PubMed  Google Scholar 

  3. Lou Z, Zhang W, Yu E, Meng R, Fu C (2014) Colonoscopy is the first choice for early postoperative rectal anastomotic bleeding. World J Surg Oncol 12:376

    Article  PubMed  PubMed Central  Google Scholar 

  4. Martínez-Serrano M-A et al (2009) Management of lower gastrointestinal bleeding after colorectal resection and stapled anastomosis. Tech Coloproctology 13:49–53

    Article  Google Scholar 

  5. DeBarros J et al (2002) The changing paradigm for the treatment of colonic hemorrhage: superselective angiographic embolization. Dis Colon Rectum 45:802–808

    Article  PubMed  Google Scholar 

  6. Denet C, Perniceni T (2002) Laparoscopic colonic splenic flexure mobilization: surgical technique. Ann Chir 127:718–721, discussion 722

    Article  PubMed  Google Scholar 

  7. Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  8. Tuchmann A, Dinstl K, Strasser K, Armbruster C (1985) Stapling devices in gastrointestinal surgery. Int Surg 70:23–27

    CAS  PubMed  Google Scholar 

  9. McGinn FP, Gartell PC, Clifford PC, Brunton FJ (1985) Staples or sutures for low colorectal anastomoses: a prospective randomized trial. Br J Surg 72:603–605

    Article  CAS  PubMed  Google Scholar 

  10. DuBois JJ, Ostrow LB, Smith GB, Welling DR (1989) Transcatheter embolization of small bowel anastomosis: a case report and review of the literature. Mil Med 154:505–507

    CAS  PubMed  Google Scholar 

  11. Aurello P, D’Angelo F, Pozzi G et al (1991) Terapia dell’emorragia anastomotica massiva dopo resezione retto-colica anteriore meccanica. G Chir 12:164–165

    CAS  PubMed  Google Scholar 

  12. Atabek U, Pello MJ, Spence RK et al (1992) Arterial vasopressin for control of bleeding from a stapled intestinal anastomosis. Report of two cases. Dis Colon Rectum 35:1180–1182

    Article  CAS  PubMed  Google Scholar 

  13. Cirocco WC, Golub RW (1995) Endoscopic treatment of postoperative hemorrhage from a stapled colorectal anastomosis. Am Surg 61:460–463

    CAS  PubMed  Google Scholar 

  14. Fingerhut A, Hay JM, Elhadad A et al (1995) Supraperitoneal colorectal anastomosis: hand-sewn versus circular staples – a controlled clinical trial. French Associations for Surgical Research. Surgery 118:479–485

    Article  CAS  PubMed  Google Scholar 

  15. Pishori T, Dinnewitzer A, Zmora O et al (2004) Outcome of patients with indeterminate colitis undergoing a double-stapled ileal pouch-anal anastomosis. Dis Colon Rectum 47:717–721

    Article  PubMed  Google Scholar 

  16. Zhao WT, Hu FL, Li YY, Li HJ, Luo WM, Sun F (2013) Use of a transanal drainage tube for prevention of anastomotic leakage and bleeding after anterior resection for rectal cancer. World J Surg 37:227–232

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  18. Perez RO, Sousa A Jr, Bresciani C, Proscurshim I, Coser R, Kiss D, Habr-Gama A (2007) Endoscopic management of postoperative stapled colorectal anastomosis hemorrhage. Tech Coloproctol 11:64–66

    Article  CAS  PubMed  Google Scholar 

  19. Amr MA, Alzghari MJ, Polites SF, Khasawneh MA, Morris DS, Baron TH, Zielinski MD (2014) Endoscopy in the early postoperative setting after primary gastrointestinal anastomosis. J Gastrointest Surg 18:1911–1916

    Article  PubMed  Google Scholar 

  20. Malik AH, East JE, Buchanan GN, Kennedy RH (2008) Endoscopic haemostasis of staple-line haemorrhage following colorectal resection. Colorectal Dis 10:616–618

    Article  CAS  PubMed  Google Scholar 

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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

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Authors and Affiliations

  1. Department of Digestive Disease, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France

    Romain Besson, Christos Christidis, Christine Denet, Laurence Bruyns, Hugues Levard, Brice Gayet, David Fuks & Thierry Perniceni

  2. Université Paris Descartes, 15 Rue de l’École de Médecine, 75006, Paris, France

    Brice Gayet & David Fuks

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  1. Romain Besson
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  2. Christos Christidis
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  3. Christine Denet
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Correspondence to David Fuks.

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Besson, R., Christidis, C., Denet, C. et al. Management of postoperative bleeding after laparoscopic left colectomy. Int J Colorectal Dis 31, 1431–1436 (2016). https://doi.org/10.1007/s00384-016-2612-8

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  • DOI: https://doi.org/10.1007/s00384-016-2612-8

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