Feasibility and Safety of Intraoperative Colonoscopy After Segmental Colectomy and Primary Anastomosis for Partial Colonic Obstruction

Ray S King, MD, PhD, Erika Simmerman, DO, P B Ham, MD, Zachary Klaassen, MD, Vendie Hooks, MD. Medical College of Georgia

BACKGROUND:  Patients presenting with endoscopically-proven partially obstructing colon lesions requiring segmental colectomy, who were unable to complete their pre-operative colonoscopy due to the inability to pass the colonoscope beyond the lesion, may benefit from intraoperative colonoscopy after primary anastomosis for a more timely and accurate diagnosis of synchronous lesions. 

OBJECTIVE: The aim of this study is to demonstrate the feasibility and safety of intra-operative completion colonoscopy after primary anastomosis following segmental colectomy in the management of patients who received incomplete preoperative colonoscopy secondary to partial obstruction.

DESIGN AND SETTING: This was a retrospective cohort study over a 5-year period of 168 patients undergoing single-stage segmental colectomy and anastomosis at a single tertiary care institution in the United States.  78 patients (46%) with incomplete preoperative colonoscopy due to partial obstruction received intraoperative colonoscopy after the anastomosis.

MAIN OUTCOME MEASURES: Detection rates of proximal synchronous lesions, occurrence of post-operative anastomotic leak and other complications, operative time, and length of hospital stay.

RESULTS: Intraoperative colonoscopy detected synchronous adenomatous polyps in 19 patients (24.4%), diverticular disease in 15 patients (19%), and colitis/proctitis in 2 patients (2.5%). The overall morbidity in the intraoperative colonoscopy group was 12.8%, with anastomotic leakage in 1 patient, wound infection in 4 patients, and postoperative ileus in 5 patients. The risk of these complications was not significantly increased when compared to those patients who received preoperative colonoscopy . (Intraoperative: 29% vs. Preoperative: 37% p= 0.01) The operation time was 19 minutes longer in the intraoperative group, but overall length of hospital stay was not significantly different between the two groups (Intraoperative: 6.4±2.9 days vs. Preoperative: 7.3±4.6 days ).

CONCLUSIONS: In patients who received incomplete preoperative colonoscopy due to partial obstruction, intraoperative colonoscopy after segmental resection and primary anastomosis is both a feasible and safe strategy for detecting proximal synchronous lesions. This technique does not appear to cause an increase in anastomotic leak rates, postoperative complications, or length of hospital stay.

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