Intraoperative colonoscopy for the assessment and prevention of anastomotic leakage in low anterior resection for rectal cancer

Seung Yoon Yang, Jeonghee Han, Yoon Dae Han, Min Soo Cho, Hyuk Hur, Kang Young Lee, Namkyu Kim, Byung Soh Min

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Purpose: Anastomotic leakage (AL) after stapled anastomosis in rectal cancer surgery is a major concern. Various types of intraoperative anastomotic air leakage tests (ALTs) have been proposed to reduce AL. This study aimed to evaluate the impact of intraoperative colonoscopy (IOC) as an intraoperative ALT in low anterior resection for rectal cancer. Methods: A total of 1266 patients were retrospectively reviewed. Among them, 215 patients who underwent IOC as an ALT in rectal cancer surgery were identified. IOC was performed after anastomosis to visualize the anastomosis line and to perform an ALT by insufflating the neorectum. Propensity score matching was used to match this group at a 1:1 ratio with 215 patients who underwent ALT with a 250-mL bulb irrigation syringe. Anastomotic defects that were found intraoperatively were resolved either by means of primary repair of the anastomotic defect, if possible, or by performing a preventive diverting ileostomy. Results: The patient characteristics, pathologic outcomes, and operation details showed no significant difference between the two groups. Comparison of the AL rate showed a significant difference between the groups (IOC group without intraoperative leaks vs. non-IOC group without intraoperative leaks 4.3 vs. 11.7%, P = 0.007). The incidence of preventive diverting ileostomy because of a positive ALT was significantly higher in the IOC group than in the non-IOC group (10 vs. 2 cases, P = 0.036). Conclusion: IOC can be a valuable method for the assessment of stapled anastomosis and has the additional benefit of directly visualizing the anastomosis line.

Original languageEnglish
Pages (from-to)709-714
Number of pages6
JournalInternational Journal of Colorectal Disease
Volume32
Issue number5
DOIs
Publication statusPublished - 2017 May 1

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Anastomotic Leak
Colonoscopy
Rectal Neoplasms
Air
Ileostomy
Propensity Score
Syringes
Incidence

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this

Yang, Seung Yoon ; Han, Jeonghee ; Han, Yoon Dae ; Cho, Min Soo ; Hur, Hyuk ; Lee, Kang Young ; Kim, Namkyu ; Min, Byung Soh. / Intraoperative colonoscopy for the assessment and prevention of anastomotic leakage in low anterior resection for rectal cancer. In: International Journal of Colorectal Disease. 2017 ; Vol. 32, No. 5. pp. 709-714.
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abstract = "Purpose: Anastomotic leakage (AL) after stapled anastomosis in rectal cancer surgery is a major concern. Various types of intraoperative anastomotic air leakage tests (ALTs) have been proposed to reduce AL. This study aimed to evaluate the impact of intraoperative colonoscopy (IOC) as an intraoperative ALT in low anterior resection for rectal cancer. Methods: A total of 1266 patients were retrospectively reviewed. Among them, 215 patients who underwent IOC as an ALT in rectal cancer surgery were identified. IOC was performed after anastomosis to visualize the anastomosis line and to perform an ALT by insufflating the neorectum. Propensity score matching was used to match this group at a 1:1 ratio with 215 patients who underwent ALT with a 250-mL bulb irrigation syringe. Anastomotic defects that were found intraoperatively were resolved either by means of primary repair of the anastomotic defect, if possible, or by performing a preventive diverting ileostomy. Results: The patient characteristics, pathologic outcomes, and operation details showed no significant difference between the two groups. Comparison of the AL rate showed a significant difference between the groups (IOC group without intraoperative leaks vs. non-IOC group without intraoperative leaks 4.3 vs. 11.7{\%}, P = 0.007). The incidence of preventive diverting ileostomy because of a positive ALT was significantly higher in the IOC group than in the non-IOC group (10 vs. 2 cases, P = 0.036). Conclusion: IOC can be a valuable method for the assessment of stapled anastomosis and has the additional benefit of directly visualizing the anastomosis line.",
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Intraoperative colonoscopy for the assessment and prevention of anastomotic leakage in low anterior resection for rectal cancer. / Yang, Seung Yoon; Han, Jeonghee; Han, Yoon Dae; Cho, Min Soo; Hur, Hyuk; Lee, Kang Young; Kim, Namkyu; Min, Byung Soh.

In: International Journal of Colorectal Disease, Vol. 32, No. 5, 01.05.2017, p. 709-714.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Intraoperative colonoscopy for the assessment and prevention of anastomotic leakage in low anterior resection for rectal cancer

AU - Yang, Seung Yoon

AU - Han, Jeonghee

AU - Han, Yoon Dae

AU - Cho, Min Soo

AU - Hur, Hyuk

AU - Lee, Kang Young

AU - Kim, Namkyu

AU - Min, Byung Soh

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Purpose: Anastomotic leakage (AL) after stapled anastomosis in rectal cancer surgery is a major concern. Various types of intraoperative anastomotic air leakage tests (ALTs) have been proposed to reduce AL. This study aimed to evaluate the impact of intraoperative colonoscopy (IOC) as an intraoperative ALT in low anterior resection for rectal cancer. Methods: A total of 1266 patients were retrospectively reviewed. Among them, 215 patients who underwent IOC as an ALT in rectal cancer surgery were identified. IOC was performed after anastomosis to visualize the anastomosis line and to perform an ALT by insufflating the neorectum. Propensity score matching was used to match this group at a 1:1 ratio with 215 patients who underwent ALT with a 250-mL bulb irrigation syringe. Anastomotic defects that were found intraoperatively were resolved either by means of primary repair of the anastomotic defect, if possible, or by performing a preventive diverting ileostomy. Results: The patient characteristics, pathologic outcomes, and operation details showed no significant difference between the two groups. Comparison of the AL rate showed a significant difference between the groups (IOC group without intraoperative leaks vs. non-IOC group without intraoperative leaks 4.3 vs. 11.7%, P = 0.007). The incidence of preventive diverting ileostomy because of a positive ALT was significantly higher in the IOC group than in the non-IOC group (10 vs. 2 cases, P = 0.036). Conclusion: IOC can be a valuable method for the assessment of stapled anastomosis and has the additional benefit of directly visualizing the anastomosis line.

AB - Purpose: Anastomotic leakage (AL) after stapled anastomosis in rectal cancer surgery is a major concern. Various types of intraoperative anastomotic air leakage tests (ALTs) have been proposed to reduce AL. This study aimed to evaluate the impact of intraoperative colonoscopy (IOC) as an intraoperative ALT in low anterior resection for rectal cancer. Methods: A total of 1266 patients were retrospectively reviewed. Among them, 215 patients who underwent IOC as an ALT in rectal cancer surgery were identified. IOC was performed after anastomosis to visualize the anastomosis line and to perform an ALT by insufflating the neorectum. Propensity score matching was used to match this group at a 1:1 ratio with 215 patients who underwent ALT with a 250-mL bulb irrigation syringe. Anastomotic defects that were found intraoperatively were resolved either by means of primary repair of the anastomotic defect, if possible, or by performing a preventive diverting ileostomy. Results: The patient characteristics, pathologic outcomes, and operation details showed no significant difference between the two groups. Comparison of the AL rate showed a significant difference between the groups (IOC group without intraoperative leaks vs. non-IOC group without intraoperative leaks 4.3 vs. 11.7%, P = 0.007). The incidence of preventive diverting ileostomy because of a positive ALT was significantly higher in the IOC group than in the non-IOC group (10 vs. 2 cases, P = 0.036). Conclusion: IOC can be a valuable method for the assessment of stapled anastomosis and has the additional benefit of directly visualizing the anastomosis line.

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U2 - 10.1007/s00384-017-2767-y

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JF - International Journal of Colorectal Disease

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