Yoo Sung Lee, Hyung Jin Kim, Seung Rim Han, Ri-Na Yoo, Gun Kim, Hyeon-Min Cho. Department of Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea
Introduction: Anastomotic complication after stapled anastomosis in colorectal cancer surgery is a considerable problem. There are various types of anastomotic complication and they have different severity. This study was aimed to evaluate the impact of intraoperative colonoscopy on detection of anastomotic complication, and its effectiveness in treatment of anastomotic complications after anterior resection (AR) and low anterior resection (LAR) for colorectal cancer intraoperatively.
Methods: From Dec. 2016 to Jul. 2017, a total of 72 patients who underwent anastomosis between sigmoid colon and rectum after colorectal resection were reviewed retrospectively. Intraoperative colonoscopy was performed routinely since December 2016 in our hospital after anterior resection and low anterior resection. To identify effectiveness of intraoperative colonoscopy, we compared postoperative complications with non-intraoperative colonoscopy group during previous 11 months. Intraoperative colonoscopy was performed after anastomosis to visualize the anastomosis line and to perform an air leakage test. If anastomotic defect and moderate bleeding were found in intraoperative colonoscopy, it was managed by means of reinforcement suture or transanal suture repair. We used Logistic regression to analyze anastomotic complication between two groups with or without intraoperative colonoscopy.
Results: Of the 72 patients who were performed intraoperative colonoscopy after AR (n=50) and LAR (n=22), abnormal findings including bleeding and air leak were found in 14 patients (19.4%). Among those, 9 cases were observed without any procedure, additional procedures were performed in 5 patients (6.9%, transanal suture (3), Lembert suture (2)). Postoperative complication was developed in 12 patients; 6 patients had anastomosis bleeding (8.3%), 2 patients had ileus (2.8%), 1 patient had pneumonia (1.4%), 3 patients had minor complication (4.2%, acute urinary retention, chylous drainage, laparoscopic port site bleeding). Among 6 patients who had anastomosis bleeding, 4 patients were treated by endoscopic clipping, 2 patients were cured by conservative treatment. There was no postoperative anastomotic leakage. The cases of AR and LAR were 62 and 48 in non-intraoperative colonoscopy group, there was no significant difference between two group (P=0.07). The proportion of laparoscopic surgery was 86.4% and 92.2% on intraoperative colonoscopy and non-intraoperative colonoscopy group, respectively, there was significant difference statistically (P=0.02). However, there was no significant difference in anastomotic complication rate between two groups. (RR = 0.27, 95% CI, 0.34-2.585).
Conclusions: Although there was no significant difference in postoperative anastomotic complication rate between two groups, intraoperative colonoscopy may be valuable method for decreasing postoperative complication by visualizing anastomosis line and performing additional procedure.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88303
Program Number: P245
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster