General and Minimally Invasive Surgery, Infermi Hospital of Rimini, AUSL Della Romagna, Via Luigi Settembrini 2, 47923, Rimini, Italy.
Updates Surg. 2020 Dec;72(4):999-1004. doi: 10.1007/s13304-020-00746-1. Epub 2020 Mar 17.
Colorectal anastomosis is the one at higher risk of complication in alimentary tract surgery. Several techniques have been used to intraoperatively check a colorectal anastomosis, without reaching a clear consensus. The aim of the present study is to evaluate the addition of intraoperative flexible endoscopy to indocyanine green fluorescence in detecting colorectal anastomotic defects in a consecutive series of patients. This was a pilot study conducted over a 15-month period. Patients were scheduled for an elective laparoscopic left colectomy or anterior resection with a planned stapled colorectal anastomosis. Pre-, intra- and postoperative data were collected. Intraoperative endoscopy was routinely performed and the anastomotic defects were classified. A suture reinforcement of the defect encountered was immediately performed either laparoscopically or transanally. The primary endpoint of the study was the rate of postoperative complications. Fitfty-two patients were enrolled. At intraoperative endoscopy, 12 anastomotic defects were detected and corrected with immediate suture reinforcement. Defects were classified as two leaks, two mucosal crash, one simultaneous leak and crash, one mucosal edema and six active bleedings. None of these patients developed any postoperative complication. Moreover, there was no postoperative bleeding complication in the entire cohort. The three patients developing a postoperative leak requiring anastomosis takedown were at high risk due to general status and cancer characteristics. Even though more data and a comparative group are needed, the results of this pilot study are very promising regarding the role of intraoperative endoscopy and suture reinforcement of a colorectal anastomotic defect.
肠吻合术是消化道手术中并发症风险较高的一种。目前已经有几种技术被用于术中检查结直肠吻合口，但尚未达成明确共识。本研究旨在评估术中使用柔性内镜联合吲哚菁绿荧光检测在连续系列患者中检测结直肠吻合口缺陷的效果。这是一项为期 15 个月的试点研究。患者计划接受择期腹腔镜左结肠切除术或前切除术，并进行吻合器吻合。收集术前、术中及术后数据。常规进行术中内镜检查，并对吻合口缺陷进行分类。对于发现的缺陷，立即进行缝合加固，可通过腹腔镜或经肛门进行。本研究的主要终点是术后并发症的发生率。共纳入 52 例患者。术中内镜检查发现 12 例吻合口缺陷，并立即进行缝合加固。缺陷分为 2 例渗漏、2 例黏膜破裂、1 例同时渗漏和破裂、1 例黏膜水肿和 6 例活动性出血。这些患者均未发生任何术后并发症。此外，整个队列中均无术后出血并发症。术后出现吻合口漏需要再次手术的 3 例患者，由于一般状态和癌症特征，存在较高的风险。尽管还需要更多的数据和对照组，但本研究的初步结果表明，术中内镜检查和缝合加固结直肠吻合口缺陷具有很好的应用前景。
