Does intra‐operative flexible endoscopy reduce anastomotic complications following left‐sided colonic resections? A systematic review and meta‐analysis

Abstract

Aim Postoperative anastomotic leakage (AL) or bleeding (AB) significantly impacts on patient outcome following colorectal resection. To minimize such complications, surgeons can utilize different techniques perioperatively to assess anastomotic integrity. We aim to assess published anastomotic complication rates following left‐sided colonic resection, comparing the use of intra‐operative flexible endoscopy (FE) against conventional tests used to assess anastomotic integrity. Methods PubMed/MEDLINE and Embase online databases were searched for non‐randomized and randomized case–control studies that investigated postoperative AL and/or AB rates in left‐sided colonic resections, comparing intra‐operative FE against conventional tests. Data from eligible studies were pooled, and a meta‐analysis using Review Manager 5.3 software was performed to assess for differences in AL and AB rates. Results Data from six studies were analysed to assess the impact of FE on postoperative AL and AB rates (1084 and 751 patients respectively). Use of FE was associated with reduced postoperative AL and AB rates, from 6.9% to 3.5% and 5.8% to 2.4% respectively. Odds ratios favoured intra‐operative FE: 0.37 (95% CI 0.21–0.68, P = 0.001) for AL and 0.35 (95% CI 0.15–0.82, P = 0.02) for AB. Conclusion This meta‐analysis showed that the use of intra‐operative FE is associated with a reduced rate of postoperative AL and AB, compared to conventional anastomotic testing methods.

Utility of intra‐operative flexible sigmoidoscopy to assess colorectal anastomosis: a systematic review and meta‐analysis

“…Previous studies have shown that IOFS can identify immediate bleeding from an anastomosis 6,12 and that leads to a significant reduction in AB rates 10 . Our study, incorporating pooled data from our included studies, shows that IOFS is associated with a statistically significant reduction in the incidence AB requiring intervention.…”

“…Our systematic review and meta‐analysis builds on the findings of Aly et al 10 . by including Shibuya et al ., 20 having been published subsequently, and Li et al 17 .…”

“…Recently, there have been several publications including a systematic review and meta‐analysis 10 advocating for the use of intra‐operative flexible sigmoidoscopy (IOFS) for anastomotic assessment 6,11,12 . IOFS has been shown to increase the likelihood of detecting an AL and reduce the risk of post‐operative anastomotic bleeding (AB).…”

Colorectal resection in endometriosis patients: correlation between histopathological findings and postoperative outcome

“…In these two cases, a protective loop ileostomy had been performed in primary procedure. The risk for anastomotic leakage differs in the literature between 7 and 30% [28][29][30]. To reduce the anastomotic leakage rate, we introduced intraoperative flexible endoscopy for air leak testing immediately after stapling of the anastomosis during the study period.…”

Colorectal Resection in Endometriosis Patients: Correlation Between Histopathological Findings and Postoperative Outcome.

“…In these two cases a protective loop ileostomy had been performed in primary procedure. The risk for anastomotic leakage differs in literature between 7-30% [28][29][30]. To reduce the anastomotic leakage rate, we introduced intraoperative exible endoscopy for air leak testing immediately after stapling of the anastomosis during the study period.…”