Immediate assessment of colorectal anastomosis with intraoperative colonoscopy: its role in reducing anastomotic complications

Abstract

Abstract Purpose The use of intraoperative colonoscopy (IOC) to evaluate the integrity of newly created anastomosis has been advocated by some surgeons. However, it is still unclear whether direct visualization of fresh anastomosis can help reduce anastomotic problems. This study investigates the impact of immediate endoscopic assessment of colorectal anastomosis on anastomotic problems. Methods This is a retrospective cohort study conducted at a single center. Of 1210 patients undergoing radical resection for colorectal cancer from 2017 to 2021, 649 patients who underwent stapled anastomosis for left-sided colorectal cancer were included in the study. The anastomotic complications were compared between patients who underwent IOC immediately after creating the colorectal anastomosis and those who did not. Additionally, patients with subsequent intervention after the IOC assessment were compared to those without the intervention. Results Of 541 patients with IOC assessment, twenty-seven patients (5.0%) developed anastomotic leakage, and six (1.1%) experienced anastomotic bleeding postoperatively. The anastomotic leakage rate was similar to that in patients who did not undergo IOC (4.6%). Of the patients with IOC, 70 patients (12.9%) received reinforcement sutures to secure anastomotic stability. Of 70 patients, thirty-nine (55.7%) showed abnormal findings of mucosal edema, stapler disruption, bleeding, and air leakage in IOC. Thirty-seven patients (94.9%) who underwent reinforcement sutures did not develop postoperative anastomotic problems; however, two patients developed postoperative anastomotic leakage. Those two patients underwent reoperation due to proximal limb ischemia. Conclusion This study demonstrates that IOC assessment with reinforcement sutures does not imminently reduce the rate of anastomotic complications in stapled left-sided colorectal anastomosis. However, its routine use may play a role in detecting early technical failure and preventing postoperative anastomotic complications in some patients. Regarding its limitation in detecting progressive ischemia, an investigation into the indocyanine green (ICG) test combined with the endoscopic assessment would help elucidate the optimal anastomosis condition.