The use of intraoperative endoscopy for early detection and prevention of gastrointestinal anastomotic complications

Objective. To assess the role of intraoperative endoscopy in early detection and prevention of gastrointestinal anastomotic complications. Material and methods. Between June 2015 and March 2016, 41 patients underwent surgery on the gastrointestinal tract (32 - left side of colon, 9 - stomach and esophagus) with primary anastomosis and its intraoperative endoscopic evaluation (we assessed bleeding and integrity). Results. Intraoperative endoscopy after left-sided colorectal surgery didn't show any anastomotic leak (air leakage test was negative). There were not postoperative clinical leaks. Anastomotic bleeding was detected in 1 case (3%) and required clipping. Intraoperative endoscopy after surgery on the stomach and esophagus showed leak in 1 case (11,1%), after subtotal distal resection of the stomach, and required oversewing of the suture line. Anastomotic bleedings were not detected. There was 1 postoperative clinical leak (11,1%) after gastrectomy, which required stent placement in this area. Conclusions. Intraoperative endoscopy is safe and useful. It can detect anastomotic leakage (positive air leakage test) and bleeding. These complications can be repaired by oversewing of the suture line (in case of leakage) or clipping (in case of bleeding) at the time of surgery.

Cingi A., Yavuz Y. Intraoperative endoscopic assessment of the pouch and anastomosis during laparoscopic Roux-en-Y gastric bypass. Obes. Surg. 2011; 21 (10): 1530-4.

Shamiyeh A., Szabo K., Ulf Wayand W., Zehetner J. Intraoperative endoscopy for the assessment of circular-stapled anastomosis in laparoscopic colon surgery. Surg. Laparosc. Endosc. Percutan. Tech. 2012; 22 (1): 65-7.

Ka Ming Li V., Wexner S.D., Pulido N., Wang H., Yin Jin H., Weiss E.G. et al. Use of routine intraoperative endoscopy in elective laparoscopic colorectal surgery: can it further avoid anastomotic failure? Surg Endosc. 2009; 23 (11): 2459-65.

Kamal T., Pai A., Velchuru V.R., Zawadzki M., Park J.J., Marecik S.J. et al. Should anastomotic assessment with flexible sigmoidoscopy be routine following laparoscopic restorative left colorectal resection? Colorectal Dis. 2015; 17 (2): 160-4.

Ivanov D., Cvijanović R., Gvozdenović L. Intraoperative air testing of colorectal anastomoses. Srp. Arh. Celok. Lek. 2011; 139 (5-6): 333-8.

Lieto E., Orditura M., Castellano P., Pinto M., Zamboli A., De Vita F. et al. Endoscopic intraoperative anastomotic testing may avoid early gastrointestinal anastomotic complications. A prospective study. J. Gastrointest. Surg. 2011; 15 (1): 145-52.

Ishihara S., Watanabe T., Nagawa H. Intraoperative colonoscopy for stapled anastomosis in colorectal surgery. Surg. Today. 2008; 38 (11): 1063-5.

Lanthaler M., Biebl M., Mittermair R., Ofner D., Nehoda H. Intraoperative colonoscopy for anastomosis assessment in laparoscopically assisted left-sided colon resection: is it worthwhile? J. Laparoendosc. Adv. Surg. Tech. A. 2008; 18 (1): 27-31.

Champion J.K., Hunt T., DeLisle N. Role of routine intraoperative endoscopy in laparoscopic bariatric surgery. Surg. Endosc. 2002; 16 (12): 1663-5.

Al Hadad M., Dehni N., Elamin D., Ibrahim M., Ghabra S., Nimeri A. Intraoperative endoscopy decreases postoperative complications in laparoscopic Roux-en-Y gastric bypass. Obes. Surg. 2015; 25 (9): 1711-5.

Alaedeen D., Madan A.K., Ro C.Y., Khan K.A., Martinez J.M., Tichansky D.S. Intraoperative endoscopy and leaks after laparoscopic Roux-en-Y gastric bypass. Am. Surg. 2009; 75 (6): 485-8.

Alasfar F., Chand B. Intraoperative endoscopy for laparoscopic Roux-en-Y gastric bypass: leak test and beyond. Surg. Laparosc. Endosc. Percutan. Tech. 2010; 20 (6): 424-7.

Milsom J.W., Pavoor R.S., Shukla P.J. Evaluating the vascularity of intestinal anastomoses - can narrow band imaging play a role? Med. Hypotheses. 2011; 77 (2): 290-3.