title: Colorectal anastomotic integrity after anterior resection: is there a role for intraoperative testing?
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.
authors.affiliation: Peterborough District Hospital, UK.
authors.forename: A R
authors.initials: AR
authors.lastname: Dixon
authors.forename: J T
authors.initials: JT
authors.lastname: Holmes
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D002277:Carcinoma / Q000601:surgery*; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008026:Ligation; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D014945:Wound Healing