Shamiyeh Andreas, Szabo Kornel, Ulf Wayand Wolfgang, Zehetner Joerg
Ludwig Boltzmann Institute for Operative Laparoscopy, 2nd Surgical Department, Academic Teaching Hospital, AKH Linz, Austria.
Surg Laparosc Endosc Percutan Tech. 2012 Feb;22(1):65-7. doi: 10.1097/SLE.0b013e3182401e20.
Anastomotic bleeding after a circular-stapled anastomosis in laparoscopic colon resections is a rare but extremely aggravating complication. An intraoperative endoscopic assessment of the anastomosis allows immediate evaluation regarding bleeding and possible leakage. The aim of the study was to evaluate the impact of routine intraoperative endoscopy on postoperative complications.
Since May 1999, data of all laparoscopic colon resections were collected in a prospective database. Since July 2007, we assessed every circular-stapled anastomosis with a flexible endoscope for bleeding, integrity of mucosa, and leakage. The patients with (+) and without (-) routine endoscopic assessment were compared regarding postoperative complications.
Group(-) consisted of 253 patients [133 male, 120 female; mean age, 60 years (25 to 86 y)] and group(+) consisted of 85 patients [44 male, 41 female; mean age, 62 years (22 to 87 y), P=not significant] In group(-), postoperative anastomotic bleeding was diagnosed in 11 patients (4.3%) and 7 (2.8%) of these patients required endoscopic assessment and clipping. In group(+), endoscopy showed anastomotic bleeding in 5 patients (5.9%) at the time of surgery, which required clipping. Anastomotic leak was observed in 2 patients (2.4%): in one patient the circular staple line was oversewn and in the other patient anastomosis was redone. Two (2.4%) patients in group(+) had postoperative anastomotic bleeding requiring reendoscopy and clipping. The postoperative leakage rate was not significantly different in both the groups [(-)1.6%, (+)1.2%, P= not significant].
Intraoperative endoscopic assessment of circular-stapled anastomosis can detect early anastomotic bleeding and leakage. Although the postoperative rate of bleeding and leakage was not significantly reduced in our study, we still recommend endoscopic assessment of the circular-stapled anastomosis as a routine procedure in colorectal surgery, as the benefits outweigh the risks.
腹腔镜结肠切除术中圆形吻合器吻合术后吻合口出血是一种罕见但极其严重的并发症。术中对吻合口进行内镜评估可立即对出血和可能的渗漏情况进行评估。本研究的目的是评估常规术中内镜检查对术后并发症的影响。
自1999年5月起，所有腹腔镜结肠切除术的数据均收集于一个前瞻性数据库中。自2007年7月起，我们使用柔性内镜对每例圆形吻合器吻合术进行出血、黏膜完整性及渗漏情况的评估。对接受（+）和未接受（-）常规内镜评估的患者的术后并发症情况进行比较。
（-）组包括253例患者[男性133例，女性120例；平均年龄60岁（25至86岁）]，（+）组包括85例患者[男性44例，女性41例；平均年龄62岁（22至87岁），P值无统计学意义]。在（-）组中，11例患者（4.3%）被诊断为术后吻合口出血，其中7例（2.8%）患者需要进行内镜评估及钳夹止血。在（+）组中，内镜检查显示5例患者（5.9%）在手术时存在吻合口出血，需要进行钳夹止血。观察到2例患者（2.4%）发生吻合口漏：1例患者对圆形吻合钉线进行了加固缝合，另1例患者重新进行了吻合。（+）组中有2例（2.4%）患者术后发生吻合口出血，需要再次进行内镜检查及钳夹止血。两组的术后渗漏率无显著差异[（-）组1.6%，（+）组1.2%，P值无统计学意义]。
术中对圆形吻合器吻合术进行内镜评估可早期发现吻合口出血及渗漏。虽然在我们的研究中术后出血和渗漏率并未显著降低，但我们仍建议将圆形吻合器吻合术的内镜评估作为结直肠手术的常规操作，因为其益处大于风险。
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