Abstract
Background
Anastomotic complications such as leakage and bleeding remain among the most serious complications of laparoscopic colorectal surgery. No perfect method exists for accurate and reliable avoidance of these catastrophes. This study aimed to study the usefulness of routine intraoperative endoscopy (RIOE) by comparing the surgical outcomes for RIOE patients with those for selective intraoperative endoscopy (SIOE) patients.
Methods
A retrospective chart review was performed for consecutive patients who underwent elective laparoscopic colorectal resections with distal anastomosis between January 2004 and May 2007. One surgeon performed RIOE, whereas the other three surgeons performed SIOE as necessary. All the abnormalities of IOE patients were managed with a subsequent salvage procedure, and the postoperative outcomes were compared between the RIOE and SIOE groups.
Results
The study included 107 patients in the RIOE group and 137 patients in the SIOE group. Abnormalities were detected in 11 RIOE patients (10.3%) (six with staple line bleeding, three with positive air leak test results, and two with additional pathology identified). All but one abnormality was laparoscopically managed without conversion to laparotomy. Whereas one patient experienced postoperative staple line bleeding that required a second operation, the remaining 10 patients recovered uneventfully. The mean hospital stay was 6 days (range, 4–9) days. The RIOE group had overall rates of 0% for anastomotic leakage and 0.9% for staple line bleeding. Intraoperative endoscopies were performed for 30 (21.9%) of the 137 patients in the SIOE group. The postoperative outcomes comparison between the RIOE and SIOE groups showed a tendency toward more overall anastomotic complications (0.9% vs. 5.1%) in the SIOE group, which due to the small sample size did not translate into significant differences in terms of staple line bleeding and anastomotic leakage. There also were no significant differences in other outcomes such as ileus, abdominal or pelvic sepsis, reoperation, positive distal margin, distance from distal margins, length of hospital stay, or mortality.
Conclusions
Routine IOE for patients undergoing elective laparoscopic colorectal surgery with distal anastomosis can detect abnormalities at or around the anastomosis. Although the RIOE group had fewer postoperative anastomotic complications, due to the small sample size, the 5.7-fold increase in anastomotic failure did not translate into significantly better postoperative outcomes than the SIOE group experienced. A larger-scale single or multicenter prospective randomized study or a metaanalysis including similar studies is necessary for further investigation of this issue.
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References
Wheeler J, Gilbert J (1999) Controlled intraoperative water testing of left-sided colorectal anastomosis: are ileostomies avoidable? Ann R Coll Surg Engl 81:105–108
Lustosa SAS, Matos D, Atallah AN, Castro AA (2001) Stapled versus hand-sewn method for colorectal anastomosis surgery. Cochrane Database Syst Rev Issue 3: Article no. CD003144
Aziz O, Constantinides V, Tekkis PP, Athanasiou T, Purkayastha S, Paraskeva P, Darzi AW, Heriot AG (2006) Laparoscopic vs open surgery for rectal cancer: a meta-analysis. Ann Surg Oncol 13(3):413–424
Bruch HP, Herold A, Schiedeck T, Schwandner O (1999) Laparoscopic surgery for rectal prolapse and outlet obstruction. Dis Colon Rectum 42:1189–1195
Leung KL, Yiu RYC, Lai PBS, Lee JFY, Thung KH, Law WY (1999) Laparoscopic-assisted resection of colorectal carcinoma. Dis Colon Rectum 42:327–333
Scheidbach H, Rose J, Huegel O, Yildirim C, Kockerling F (2004) Results of laparoscopic treatment of rectal cancer: analysis of 520 patients. Tech Coloproctol 8:S22–S24
Köckerling F, Rose J, Schneider C, Scheidbach H, Scheuerlein H, Reymond MA, Reck T, Konradt J, Bruch HP, Zornig C, Bärlehner E, Kuthe A, Szinicz G, Richter HA, Hohenberger W (1999) Laparoscopic colorectal anastomosis: risk of postoperative leakage: results of multicenter study. Laparoscopic colorectal surgery study group (LCSSG). Surg Endosc 13(7):639–644
Köckerling F, Schneider C, Reymond MA, Scheidbach H, Scheuerlein H, Konradt J, Bruch HP, Zornig C, Köhler L, Bärlehner E, Kuthe A, Szinicz G, Richter HA, Hohenberger W (1999) Laparoscopic resection of sigmoid diverticulitis: results of a multi-center study. Surg Endosc 13(6):567–571
Köckerling F, Schneider C, Reymond MA, Scheidbach H, Konradt J, Bärlehner E, Bruch HP, Kuthe A, Troidl H, Hohenberger W (1998) Early results of a prospective multicenter study on 500 consecutive cases of laparoscopic colorectal surgery. Surg Endosc 12(1):37–41
Mario M, Umberto P, Giuseppe G, Micky S, Riccardo BC, Corrado G (2003) Laparoscopic total mesorectal excision: a consecutive series of 100 patients. Ann Surg 237(3):335–342
Hartley JE, Mehigan BJ, Qureshi AE, Duthie GS, Lee PWR, Monson JRT (2001) Total mesorectal excision: assessment of laparoscopic approach. Dis Colon Rectum 44(3):315–321
Anthuber M, Fuerst A, Elser F, Berger R, Jauch KW (2003) Outcome of laparoscopic surgery for rectal cancer in 101 patients. Dis Colon Rectum 46:1047–1053
Fu CG, Muto T, Masaki T (1997) Results of the double stapling procedure in colorectal surgery. Surg Today 27(8):706–709
Bruce CJ, Coller JA, Murray JJ, Schoetz DJ, Roberts PL, Rusin LC (1996) Laparoscopic resection for diverticular disease. Dis Colon Rectum 39:S1–S6
Fleshman JW, Fry RD, Birnbaum EH, Kodner IJ (1996) Laparoscopic-assisted and minilaparotomy approaches to colorectal diseases are similar in early outcomes. Dis Colon Rectum 39:15–22
Wexner SD, Latulippe JF (1998) Laparoscopic colorectal surgery and cancer. Dig Surg 15:117–123
Bowden TA (1989) Intraoperative endoscopy of the gastrointestinal tract: clinical necessity or lack of preoperative preparation? World J Surg 13(2):186–189
Sakanoue Y, Nakao K, Shoji Y, Yanagi H, Kusunoki M (1993) Intraoperative colonoscopy. Surg Endosc 7(2):84–87
Kuramoto S, Ihara O, Sakai O, Tsuchiya T, Oohara T (1998) Intraoperative colonoscopy in the detection of non-palpable colonic lesions: how to identify the affected bowel segment. Surg Endosc 2(2):76–80
Martinez SA, Hellinger MD, Martini M, Hartmann RF (1998) Intraoperative endoscopy during colorectal surgery. Surg Laparosc Endosc Percutan Tech 8(2):123–126
Kim SH, Milson JW, Church JM, Ludwig KA, Garcia-Ruiz A, Okuda J, Fazio VW (1997) Perioperative tumour localization for laparoscopic colorectal surgery. Surg Endosc 11:1013–1106
Broniatowski SG, Quadar M, Alexander F (1996) Clostridium difficile colitis in the critical ill. Dis Colon Rectum 39(6):619–623
Bergamaschi R, Arnaud JP (1997) Immediately recognizable benefits and drawbacks after laparoscopic colon resection for benign disease. Surg Endosc 11(8):802–804
Zmora O, Dinnewitzer AJ, Pikarsky AJ, Efron JE, Weiss EG, Nogueras JJ, Wexner SD (2002) Intraoperative endoscopy in laparoscopic colectomy. Surg Endosc 16:808–811
Bundy CA, Zera RT, Onstad GA, Bilodeau LL, Bubrick MP (1992) Comparative surgical and colonoscopic appearance of colon anastomosis contructed with sutures, staples, and the biofragmentable anastomotic ring. Surg Endosc 6(1):18–22
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Li, V.K.M., Wexner, S.D., Pulido, N. et al. Use of routine intraoperative endoscopy in elective laparoscopic colorectal surgery: can it further avoid anastomotic failure?. Surg Endosc 23, 2459–2465 (2009). https://doi.org/10.1007/s00464-009-0416-4
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DOI: https://doi.org/10.1007/s00464-009-0416-4