Intraoperative Colonoscopy: Is It a Better Way of Detecting
Leakage after Circular Stapler Anastomosis?
Pawit Sutharat MD1, Niwed Sithijirakorn MD1, Suwan Sanmee MD1, Paisit Siriwittayakorn MD1,
Wasana Ko-iam RN1, Wilaiwan Chongruksut RN, PhD1
Affiliation :
1 Colorectal Unit, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Background : Surgery for colorectal cancer can signi(cid:976)icantly improve the survival of patients. Although surgical techniques and
equipment have improved over the past 20 years, anastomosis leakage after colorectal cancer surgery continue to be a signi(cid:976)icant
complication. Multiple comorbidities and mortality after colorectal anastomosis leakage have been described for example, increasing
the need for a permanent colostomy and increased recurrence rate of cancer.
Objective : To evaluate the impact of intraoperative colonoscopy as an intraoperative air leak test in colorectal cancer surgery.
Materials and Methods : One new technique in the procedure of colorectal anastomosis is the circular staple autosuture, which
decreases the operative time of colorectal surgery. However, there is no standard technique for testing or checking for colorectal
anastomosis leakage.
Results : Data were collected from 33 patients who had colorectal cancer and underwent tumor resection. Eight patients (24%)
underwent surgery using the open technique, 13 patients (39%) by the laparoscopic-assisted technique, and 12 patients (36%)
by hand-assisted laparoscopic technique. After the tumor was resected, the proximal and distal end of colon and/or rectum were
anastomosed using a circular stapler. Afterwards, the anastomosis leak test was carried out by intraoperative colonoscopy to
investigate any leakage of air and/or bleeding from the anastomosis site. The intraoperative colonoscopic (cid:976)indings were compared
to the postoperative clinical evidence of possible anastomosis leakage. From the present study, there was no air leakage from the
anastomosis by using this technique, which correlated to no evidence of postoperative clinical symptoms of leakage.
Conclusion : Detection of anastomosis leakage after circular stapler by intraoperative colonoscopy is an accurate and safe technique
for the detection of leakage and bleeding.
Keywords : Intraoperative colonoscopy, Anastomosis leakage test, Circular stapler autosuture
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