Williams Evan, Prabhakaran Swetha, Kong Joseph C, Bell Stephen, Warrier Satish K, Simpson Paul, Carne Peter W G, Farmer Chip
Department of Colorectal Surgery, Alfred Hospital, Melbourne, Victoria, Australia.
Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
ANZ J Surg. 2021 Apr;91(4):546-552. doi: 10.1111/ans.16338. Epub 2020 Oct 5.
Anastomotic leak (AL) after colorectal resection leads to increased oncological and non-oncological, morbidity and mortality. Intra-operative assessment of a colorectal anastomosis with intra-operative flexible sigmoidoscopy (IOFS) has become increasingly prevalent and is an alternative to conventional air leak test. It is thought that intra-operative identification of an AL or anastomotic bleeding (AB) allows for immediate reparative intervention at the time of anastomosis formation itself. We aim to assess the available evidence for the use of IOFS to prevent complications following colorectal resection.
Following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic review of the literature between January 1980 and June 2020 was performed. Comparative studies assessing IOFS versus conventional air leak test were compared, and outcomes were pooled.
A total of 4512 articles were assessed, of which eight were found to meet the inclusion criteria. A total of 1792 patients were compared; 884 in the IOFS arm and 908 in the control arm. IOFS was associated with an increase in the rate of positive leak test (odds ratio (OR) 5.21, P > 0.001), a decrease in AL (OR 0.45, P = 0.006) and a decrease in post-operative AB requiring intervention (OR 0.40, P = 0.037).
In a non-randomized meta-analysis, IOFS increases the likelihood of identifying an anastomotic defect or bleeding intra-operatively. This allows for immediate intervention that decreases the rate of AL and AB. This adds impetus for performing routine IOFS after a left-sided colorectal resection with anastomosis and highlights the need for randomized controlled trial to confirm the finding.
结直肠切除术后吻合口漏（AL）会导致肿瘤学和非肿瘤学方面的发病率及死亡率增加。术中通过术中柔性乙状结肠镜检查（IOFS）对结直肠吻合口进行评估已越来越普遍，它是传统漏气试验的一种替代方法。人们认为术中识别AL或吻合口出血（AB）能够在吻合口形成时立即进行修复干预。我们旨在评估使用IOFS预防结直肠切除术后并发症的现有证据。
按照系统评价和Meta分析的首选报告项目指南，对1980年1月至2020年6月间的文献进行了系统评价。比较了评估IOFS与传统漏气试验的对照研究，并汇总了结果。
共评估了4512篇文章，其中8篇符合纳入标准。总共比较了1792例患者；IOFS组884例，对照组908例。IOFS与漏气试验阳性率增加相关（优势比（OR）5.21，P>0.001），AL发生率降低（OR 0.45，P = 0.006），以及术后需要干预的AB发生率降低（OR 0.40，P = 0.037）。
在一项非随机Meta分析中，IOFS增加了术中识别吻合口缺陷或出血的可能性。这使得能够立即进行干预，从而降低AL和AB的发生率。这为在左侧结直肠切除并吻合术后进行常规IOFS提供了动力，并突出了需要进行随机对照试验以证实这一发现。
