Colorectal anastomotic integrity after anterior resection: is there a role for intraoperative testing? |
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Authors: | A R Dixon J T Holmes |
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Affiliation: | Peterborough District Hospital, UK. |
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Abstract: | Two hundred and two consecutive patients having an anterior resection of the rectum were studied retrospectively to determine the usefulness of intraoperative anastomotic testing. Saline introduced via a rectal catheter was used to distend the rectum and any leaks demonstrated were oversewn. Of 119 stapled anastomoses there were two (1.7%) clinical leaks; in both cases intraoperative testing had been negative. Five patients (4.2%) had leaks demonstrated by intraluminal distension. These defects were rectified at the time of operation and no clinical sequelae followed, three patients having had a covering colostomy added. Eighty-three untested handsewn anastomoses were also reviewed; all had a postoperative recovery uncomplicated by a clinical leak. These results raise the question: does intraoperative anastomotic testing produce false positives and/or weaken the anastomosis? We believe that in the three patients who required the addition of a covering colostomy a clinical leak was avoided as a result of the intraoperative test. The technique is simple, effective and probably helps reduce leakage following colorectal anastomoses. |
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