Kamal T, Pai A, Velchuru V R, Zawadzki M, Park J J, Marecik S J, Abcarian H, Prasad L M
Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA.
Department of Colon and Rectal Surgery, University of Illinois, Chicago, Illinois, USA.
Colorectal Dis. 2015 Feb;17(2):160-4. doi: 10.1111/codi.12809.
The aim of the study was to evaluate the value of routine intra-operative flexible sigmoidoscopy (IOFS) for left-sided anastomotic integrity and to determine the safest step after a positive leak test.
All consecutive patients undergoing left-sided colorectal resections for benign and malignant disease between August 2005 and April 2011 were included. Data regarding procedure, type of anastomosis and outcomes of IOFS were collected. A positive intra-operative leak test resulted in redoing the anastomosis and repeating the leak test.
A total of 415 consecutive patients underwent hand-assisted laparoscopic colorectal resection with a colorectal/ileoanal anastomosis. All patients underwent IOFS. Seventeen patients had abnormality on IOFS. Fifteen patients had a positive air leak test. One patient had anastomotic bleeding. There was one stapler misfiring. Fourteen anastomoses were redone without diversion. One patient required diversion to protect the ileoanal anastomosis and another had already been diverted. Minor bleeding from the staple line in one patient resolved without intervention; however, he had a postoperative anastomotic leak needing surgical intervention. None of the patients who had a takedown and refashioning of the anastomosis following a positive leak on IOFS had postoperative anastomotic leakage or bleeding. Our overall anastomotic leak rate was 2.1%.
Intra-operative flexible sigmoidoscopy for restorative colorectal resection is safe and reliable and should be performed routinely to assess anastomotic integrity and bleeding. Refashioning the anastomosis after formal takedown would obviate the risk of leakage and is our recommended method of managing intra-operative leaks.
本研究旨在评估术中常规使用可弯曲乙状结肠镜检查（IOFS）对左侧吻合口完整性的价值，并确定渗漏试验阳性后最安全的步骤。
纳入2005年8月至2011年4月期间所有因良性和恶性疾病接受左侧结直肠切除术的连续患者。收集有关手术过程、吻合类型和IOFS结果的数据。术中渗漏试验阳性导致重新进行吻合并重复渗漏试验。
共有415例连续患者接受了手辅助腹腔镜结直肠切除术并进行了结直肠/回肠肛管吻合。所有患者均接受了IOFS检查。17例患者IOFS检查有异常。15例患者空气渗漏试验阳性。1例患者出现吻合口出血。有1次吻合器击发失败。14例吻合口重新进行了缝合且未行转流术。1例患者需要转流以保护回肠肛管吻合口，另1例患者已行转流术。1例患者吻合钉部位少量出血未干预自行缓解；然而，他术后出现吻合口漏需要手术干预。IOFS检查渗漏阳性后进行吻合口拆除和重新塑形的患者均未出现术后吻合口漏或出血。我们总的吻合口漏率为2.1%。
术中可弯曲乙状结肠镜检查用于结直肠修复性切除术是安全可靠的，应常规进行以评估吻合口完整性和出血情况。正式拆除后重新塑形吻合口可避免渗漏风险，是我们推荐的处理术中渗漏的方法。
