Does intra-operative flexible endoscopy reduce anastomotic complications following left-sided colonic resections?

INTRODUCTION: Post-operative anastomotic leakage (AL) or bleeding (AB) significantly impacts on patient outcome following colorectal resection. To minimise such complications, surgeons can utilise different techniques perioperatively to assess anastomotic integrity. We aim to assess published anastomotic complication rates following left-sided colonic resection, comparing use of intra-operative flexible endoscopy against conventional tests used to assess anastomotic integrity.

METHODS: PubMed/MEDLINE and EMBASE online databases were searched for non-randomised and randomised case-control studies that investigated post-operative AL and/or AB rates in left-sided colonic resections, comparing intra-operative flexible endoscopy against conventional tests. Data from eligible studies were pooled, and a meta-analysis using Review Manager 5.3 software was performed to assess for difference in AL and AB rates.

RESULTS: Data from six studies were analysed to assess the impact of flexible endoscopy on post-operative AL and AB rates (1084 and 751 patients respectively). Use of flexible endoscopy was associated with reduced post-operative AL and AB rates, from 6.9% to 3.5% and 5.8% to 2.4% respectively. OR favoured intra-operative flexible endoscopy; 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 flexible endoscopy is associated with a reduced rate of post-operative anastomotic leakage and bleeding, compared to conventional anastomotic testing methods. This article is protected by copyright. All rights reserved.