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Intraoperative endoscopy with immediate suture reinforcement of the defect in colorectal anastomosis: a pilot study

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Abstract

Colorectal anastomosis is the one at higher risk of complication in alimentary tract surgery. Several techniques have been used to intraoperatively check a colorectal anastomosis, without reaching a clear consensus. The aim of the present study is to evaluate the addition of intraoperative flexible endoscopy to indocyanine green fluorescence in detecting colorectal anastomotic defects in a consecutive series of patients. This was a pilot study conducted over a 15-month period. Patients were scheduled for an elective laparoscopic left colectomy or anterior resection with a planned stapled colorectal anastomosis. Pre-, intra- and postoperative data were collected. Intraoperative endoscopy was routinely performed and the anastomotic defects were classified. A suture reinforcement of the defect encountered was immediately performed either laparoscopically or transanally. The primary endpoint of the study was the rate of postoperative complications. Fitfty-two patients were enrolled. At intraoperative endoscopy, 12 anastomotic defects were detected and corrected with immediate suture reinforcement. Defects were classified as two leaks, two mucosal crash, one simultaneous leak and crash, one mucosal edema and six active bleedings. None of these patients developed any postoperative complication. Moreover, there was no postoperative bleeding complication in the entire cohort. The three patients developing a postoperative leak requiring anastomosis takedown were at high risk due to general status and cancer characteristics. Even though more data and a comparative group are needed, the results of this pilot study are very promising regarding the role of intraoperative endoscopy and suture reinforcement of a colorectal anastomotic defect.

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Authors and Affiliations

  1. General and Minimally Invasive Surgery, Infermi Hospital of Rimini, AUSL Della Romagna, Via Luigi Settembrini 2, 47923, Rimini, Italy

    Carlo Vallicelli, Basilio Pirrera, Vincenzo Alagna, Enrico Fantini, Gian Marco Palini, Nicola Zanini & Gianluca Garulli

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  1. Carlo Vallicelli
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  2. Basilio Pirrera
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  3. Vincenzo Alagna
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  4. Enrico Fantini
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  5. Gian Marco Palini
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  6. Nicola Zanini
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  7. Gianluca Garulli
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Correspondence to Carlo Vallicelli.

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All procedures performed in the present study were in accordance with the ethical standards of the Institutional Ethics Committee and with the Helsinki declaration and its later amendements.

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Vallicelli, C., Pirrera, B., Alagna, V. et al. Intraoperative endoscopy with immediate suture reinforcement of the defect in colorectal anastomosis: a pilot study. Updates Surg 72, 999–1004 (2020). https://doi.org/10.1007/s13304-020-00746-1

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  • DOI: https://doi.org/10.1007/s13304-020-00746-1

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