medigraphic.com
ISSN 1665-2576 (Print)

2011, Number 4

<< Back Next >>

Rev Mex Cir Endoscop 2011; 12 (4)

Intraoperative colonoscopy for anastomosis assessment in minimally invasive colorectal surgery. Six year experience

Blas FM, Téllez PD, Arenas OJ, Pichardo FMA, Velázquez GJA, Delgadillo THG, Serrano GI, Servín TE, Valenzuela SC, Hernández FJ, Cervantes MRA, Maldonado GR, Dávila ZMR, Herrera EJJ, Alonso LJO, León TAM, Gutiérrez MLI

Language: Spanish
References: 19
Page: 168-173
PDF size: 58.07 Kb.


ABSTRACT

Introduction: Even in the XXI Century, anastomotic leaks in colorectal surgery are still the main cause of morbidity and mortality; therefore, these should be performed meticulously with all the principles acquired along the evolution of colorectal surgery, especially in patients at high risk for developing an anastomotic leak. Material and methods: We performed a prospective analysis of a prolective database. We studied 167 patients who had undergone a minimally invasive procedure for benign as well as malign colorectal disease; these procedures were performed in Mexico City by a single surgeon who led two surgical teams in two different public institutions and in the private practice. The aim was to evaluate the utility of intraoperative colonoscopy to verify the integrity of intra and extracorporeal anastomoses performed with mechanical sutures. Results: We performed a prospective analysis of a prolective database. We studied 167 patients who had undergone a minimally invasive procedure for benign as well as malign colorectal disease between April 2005 and October 2011. In six patients (5.9%), during the anastomosis assessment we found: 5 (4.9%) with anastomotic leak which was repaired during surgery; 4 (3.9%) in the left lateral side of the anastomosis, 1 (0.99%) in the anterior face of the anastomosis, and 1 (0.99%) with anastomotic bleeding, which was repaired immediately. Discussion: In the field of minimally invasive colorectal surgery, as in any other surgical field, each steps of the procedure is important, nevertheless, specifically in colorectal resections requiring anastomosis, their intraoperative assessment is of vital importance, and each member of the surgical team must be highly specialized in the procedure, since these type of patients have a unique chance of conserving intestinal transit. Conclusions: Intraoperative colonoscopy is a crucial element in minimally invasive colorectal surgery. With the current information, we can foresee that if used on a regular basis in the operating room, the rate of dehiscence in laparoscopic-assisted colon resections may decrease.


REFERENCES

  1. 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 of Laparoscopic and Advanced Surgical Techniques 2008; 18: 27-31.

  2. Park UC, Chung SS, Kim KR, Seong MK, Yoon WH, Kim YJ, Baik HK, Yu CS, Kim JH. Single-stage procedure with intraoperative colonoscopy and colonic irrigation in patients with obstructing left-sided colonic cancer. Int J Colorectal Dis 2004; 19: 487-92.

  3. Nakajima K, Lee SW, Sonoda T, Milsom JW. Intraoperative carbon dioxide colonoscopy. Surg Endosc 2005; 19: 321-325.

  4. Ishihara S, Watanabe T, Nagawa H. Intraoperative colonoscopy for stapled anastomosis in colorectal surgery. Sur Today 2008; 38: 1063-65.

  5. Ivanov D, Cvijanovic R, Gvozdenovic R, Gvozdenovic L. Intraoperative air testing of colorectal anastomosis. Srp Arh Celok Lek 2011; 139: 333-338.

  6. Beard JD, Nicholson ML, Sayers RD, D. Lloyd, Everson NW. Intraoperative air testing of colorectal anastomoses: a prospective, randomized trial. Br J Surg 1990; 77: 1095-1097.

  7. Sasaki K, Kazama S, Sunami E, Tsuno NH, Nozawa H, Nagawa H, Kitayama J. One-stage segmental colectomy and primary anastomosis after intraoperative colonic irrigation and total colonoscopy for patients with obstruction due to left-sided colorectal cancer. Dis Colon Rectum 2012; 55: 72-78.

  8. Belmonte MC, Guerrero GVH, Pérez AJ, Cosme RC, Fernández DP. Sigmoidectomía laparoscópica manualmente asistida en el manejo de fístulas secundarias a enfermedad diverticular complicada. Una alternativa segura. Cir Gen 2009; 31: 175-179.

  9. Belmonte MC, García RA, Chávez RJJ, Hagerman RGG. Colectomía total laparoscópica por inercia colónica. Reporte de un caso. Cir Endosc 2002; 3: 131-136.

  10. Cosme RC, Guerrero GVH, Castañeda ML, Silver EJ, Belmoente MC. Colectomía laparoscópica manualmente asistida en cáncer del colon y recto. Cir Endosc 2008; 9: 92-96.

  11. Blas FM, Cuevas MOF, Rodríguez RF, Bernal MCA, Orozco AJI. Perforación de colon por catéter de diálisis peritoneal; reparación laparoscópica guiada por endoscopia. Endosc 2008; 20: 66-68.

  12. Jiménez BB, Villanueva HJA, Charrua GL, Ezquivel OEA, Montaño TE. Cirugía laparoscópica de colon y recto. Experiencia inicial en el Hospital General de México. Cir Gen 2008; 9: 132-138.

  13. González CQH, Moreno BJM, Jonguitud ML. Cien procedimientos colorrectales laparoscópicos asistidos. Experiencia en el Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”. Cir Endosc 2007; 8: 73-78.

  14. Rojas IMF, Rocha RJL, Saldaña GJA, Chávez VOE, Olvera FOE. Cirugía laparoscópica colorrectal videoasistida. Experiencia inicial en el Hospital de Especialidades del Centro Médico Nacional Siglo XXI. Instituto Mexicano del Seguro Social. Cir Endosc 2008; 9: 113-118.

  15. Vergara FO, González CQH, Jaramillo MC, Martínez B. Colectomía total laparoscópica asistida para inercia colónica (constipación de tránsito lento). Cir Endosc 2007; 8: 136-140.

  16. Blas FM, Rangel PJH, Almeraya OJ, Pichardo FMA. Manejo quirúrgico del prolapso rectal completo: Complicaciones en cirugía de mínima invasión versus cirugía abierta. Cir Endosc 2008; 9: 97-104.

  17. Bonjer J, Hop WCJ, Nelson H, Sargent DJ, Lacy AM. Laparoscopically assisted vs open colectomy for colon cancer. A meta-analysis transatlantic laparoscopically assisted vs open colectomy trials study group*. Arch Surg 2007; 142: 298-303.

  18. Kirchhoff P, Dincler S, Buchmann. A multivariate analysis of potential risk factors for intra and postoperative complications in 1,316 elective laparoscopic colorectal procedures. Ann Surg 2008; 248: 259-265.

  19. Blas FM, Delano AR, Picahrdo FMA, Valenzuela SC, Herrera EJJ. Estomas por cirugía de mínima invasión, experiencia de cinco años, una alternativa quirúrgica segura. Cir Endosc 2010; 11: 120-128.




2020     |     www.medigraphic.com