title: Endoscopic evaluation of clinical colorectal anastomotic leakage.
abstract: BACKGROUND
  Anastomotic leakage (AL) is a major complication after anterior resection. However, its therapeutic strategies and technical risk factors have not been well established. Therefore, we endoscopically evaluated anastomotic regions after laparoscopic colorectal anastomosis using a double-stapling technique (DST) for determination of treatment and investigation of technical factors.
  
  
  METHODS
  In total, 191 consecutive patients underwent laparoscopic anterior resection with a DST from September 2008-January 2013. Anastomotic regions were endoscopically evaluated in patients suspected to have AL after surgery.
  
  
  RESULTS
  Anastomotic dehiscence was observed in 19 patients, and AL was diagnosed in 18 (9.3%). Of the 19 patients, 12 were treated by creation of an intestinal stoma and 7 were treated conservatively based on their clinical status and endoscopic findings. Twenty-three dehiscences were observed among 19 anastomotic regions; all 23 were observed on the circular stapler anastomosis lines. Of these 23 dehiscences, 13 (56.5%) were located at the point at which the anastomosis lines of the circular and linear staplers overlapped, and 10 (43.5%) were located on the circumferential aspect between the overlapping points.
  
  
  CONCLUSIONS
  Endoscopic evaluation of anastomotic regions is safe and useful for the determination of therapeutic strategies. The DST anastomotic technique itself may be closely related to the development of AL.
authors.affiliation: Center for Integration of Advanced Medicine, Kyushu University, Fukuoka, Japan. Electronic address: t-ikeda@surg2.med.kyushu-u.ac.jp.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ikeda
authors.affiliation: Center for Integration of Advanced Medicine, Kyushu University, Fukuoka, Japan.
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Kumashiro
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Taketani
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Ando
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Yasue
authors.initials: Y
authors.lastname: Kimura
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Saeki
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Oki
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Morita
authors.affiliation: Center for Integration of Advanced Medicine, Kyushu University, Fukuoka, Japan.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Akahoshi
authors.affiliation: Center for Integration of Advanced Medicine, Kyushu University, Fukuoka, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Hashizume
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000209:etiology* / Q000473:pathology; D003106:Colon / Q000473:pathology / Q000601:surgery; D003108:Colonic Diseases / Q000209:etiology* / Q000473:pathology; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012007:Rectum / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000473:pathology; D013537:Sutures
keywords: Anastomotic leakage; Colorectal anastomoses; Colorectal cancer; Double-stapling technique; Endoscopic findings