Endoscopy for the assessment and treatment of anastomotic bleeding in laparoscopic anterior resection for rectal cancer

Jun-Jun Ma, MD, PhD, Ai-guo Lu, MD, Ya-ping Zong, MD, Bo Feng, MD, PhD, Lu Zang, MD, Min-hua Zheng, MD

Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai Minimal Invasive Surgery Center

Objective To evaluate the impact of routine intraoperative endoscopy on postoperative anastomotic bleeding of laparoscopic anterior resection (LAR) for rectal cancer, and to investigate the value of the intraoperative endoscopy in terms of prevention and treatment of postoperative anastomotic bleeding.

Methods Medical records of the 279 cases of laparoscopic anterior resection from January 2001 to December 2011 were retrospectively analyzed, 18 cases of which showed anastomotic bleeding. Univariate analysis was taken to determine the possible influencing factors of anastomotic bleeding .Then relative influencing factors were put into the multivariate Logistic analysis regression to ultimately determine the independent influencing factors of anastomotic bleeding. The efficacy of treatment of anastomotic bleeding was also evaluated.

Results The incidence of anastomotic bleeding after laparoscopic anterior resection is 6.5%(18/279).The rates of anastomotic bleeding in lower tumor location group and upper tumor location group were 9.2% (16/173) and 1.9% (2/106), in intraoperative colonoscopy and non- intraoperative colonoscopy group were 3.3% (5/151), and 10.2% (13/128), respectively. Comparing the location of the tumor (lower vs. upper), the coefficient of regression and relative risk value for lower tumor were 1.564 and 4.776. Comparing the intraoperative colonoscopy and non- intraoperative colonoscopy group, the value for intraoperative colonoscopy group were -1.085 and 0.338. Gender, age, tumor stage, pathological type, and preventive ileostomy had no relevance with anastomotic bleeding. In 18 cases of anastomotic bleeding, seven received conservative treatment, 9 underwent endoscopic treatment and 2 underwent reoperation. All cases had hemostasis successfully.

Conclusion Intraoperative endoscopy was an independent influencing factor of anastomotic bleeding after laparoscopic anterior resection. Endoscopic hemostasis was recommended for an anastomotic bleeding.

Session: Poster Presentation

Program Number: P064