title: Should anastomotic assessment with flexible sigmoidoscopy be routine following laparoscopic restorative left colorectal resection?
abstract: OBJECTIVE
  The aim of the study was to evaluate the value of routine intra-operative flexible sigmoidoscopy (IOFS) for left-sided anastomotic integrity and to determine the safest step after a positive leak test.
  
  
  METHODS
  All consecutive patients undergoing left-sided colorectal resections for benign and malignant disease between August 2005 and April 2011 were included. Data regarding procedure, type of anastomosis and outcomes of IOFS were collected. A positive intra-operative leak test resulted in redoing the anastomosis and repeating the leak test.
  
  
  RESULTS
  A total of 415 consecutive patients underwent hand-assisted laparoscopic colorectal resection with a colorectal/ileoanal anastomosis. All patients underwent IOFS. Seventeen patients had abnormality on IOFS. Fifteen patients had a positive air leak test. One patient had anastomotic bleeding. There was one stapler misfiring. Fourteen anastomoses were redone without diversion. One patient required diversion to protect the ileoanal anastomosis and another had already been diverted. Minor bleeding from the staple line in one patient resolved without intervention; however, he had a postoperative anastomotic leak needing surgical intervention. None of the patients who had a takedown and refashioning of the anastomosis following a positive leak on IOFS had postoperative anastomotic leakage or bleeding. Our overall anastomotic leak rate was 2.1%.
  
  
  CONCLUSIONS
  Intra-operative flexible sigmoidoscopy for restorative colorectal resection is safe and reliable and should be performed routinely to assess anastomotic integrity and bleeding. Refashioning the anastomosis after formal takedown would obviate the risk of leakage and is our recommended method of managing intra-operative leaks.
authors.affiliation: Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA.
authors.forename: T
authors.initials: T
authors.lastname: Kamal
authors.affiliation: Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA.
authors.forename: A
authors.initials: A
authors.lastname: Pai
authors.affiliation: Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA.
authors.forename: V R
authors.initials: VR
authors.lastname: Velchuru
authors.affiliation: Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA.
authors.forename: M
authors.initials: M
authors.lastname: Zawadzki
authors.affiliation: Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Park
authors.affiliation: Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA.
authors.forename: S J
authors.initials: SJ
authors.lastname: Marecik
authors.affiliation: Department of Colon and Rectal Surgery, University of Illinois, Chicago, Illinois, USA.
authors.forename: H
authors.initials: H
authors.lastname: Abcarian
authors.affiliation: Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA.|Department of Colon and Rectal Surgery, University of Illinois, Chicago, Illinois, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Prasad
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D057868:Anastomotic Leak / Q000209:etiology / Q000601:surgery*; D003082:Colectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D012086:Reoperation; D012189:Retrospective Studies; D012812:Sigmoidoscopy / Q000009:adverse effects* / Q000379:methods; D017792:Surgical Stapling / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome
keywords: Intra‐operative flexible sigmoidoscopy; anastomotic assessment