The Role of Flexible Endoscopy in Reducing Anastomotic Leak in Colorectal Anastmosis

Ahmad Othman, MD, Angel Morales-Gonzalez, MD, John Mistrot, Stacey Milan, MD, FACS. TTUHSC at El Paso

Introduction: Anastomotic leak (AL) following colorectal anastomosis has been associated with higher morbidity and mortality, increased length of hospital stay and increased cost of care. The use of flexible endoscopy in evaluating colorectal anastomosis can document its integrity and assist in performing a controlled air-leak test.  We hypothesized that evaluation of colorectal anastomosis using flexible endoscopy would reduce the incidence of AL.

Methods and Procedures: This is a retrospective cohort study that includes all adult patients who underwent sigmoid resection with colorectal anastomosis performed at a single academic institution between 2002 & 2012. Continuous variables were described using mean and standard deviation while categorical variables were described using frequency and percentages. Continuous cofactors were compared between patients with and without anastomotic leak using t-test or Mann-Whitney test. Categorical cofactors were compared between patients with and without anastomotic leak using Fisher’s exact test. Variables with p-value less than 0.05 were considered as statistically significant variables. All the analysis was done using SAS 9.3 statistical software.

Results: Our cohort included 178 patients. Mean age of the patients were 53 (SD=13.7) years. 14 (7.9%) patients developed AL and had a hospital LOS three times longer than patients who did not. 25 (14.2%) were performed laparoscopically with a conversion rate of 52%. 160 (90.9%) were elective procedures performed for colostomy reversal (36%), colorectal cancer (31%) and diverticular disease (25%). Only 11 (6.9%) of the elective procedures developed AL while 3 (18.8%) non-elective procedures developed AL (P-value = 0.078). 8 (15.7%) of the diabetic patients developed AL while only 6 (4.7%) of the non-diabetic patients developed AL (P-value = 0.026). All patients who underwent endoscopic evaluation of their anastomosis were elective procedures performed on non-diabetic patients. None of the patients who had their anastomosis evaluated with flexible endoscopy developed AL while 14 (9.7%) of those who did not undergo flexible endoscopy developed AL.

Conclusion: Endoscopic evaluation of colorectal anastomosis may reduce the incidence of AL.