Early Diagnosis of Colonic Anastomotic Leak With Peritoneal Endoscopy.
OBJECTIVE
At present, we do not have a reliable method for the early diagnosis of colorectal anastomotic leakage (AL). We tested peritoneal flexible endoscopy through a port placed in the abdominal wall in the early postoperative course, as a new diagnostic method for detection of this complication and evaluated the suggested method for safety, feasibility, and accuracy.


METHODS
Ten swine were randomized into 2 groups: group A, colorectal anastomosis without leakage; and group B, colorectal anastomosis with leakage. A button gastrostomy feeding tube was inserted percutaneously into the peritoneal cavity. Colorectal anastomosis (with or without defect) was created 48 hours after the first operation. The swine were examined by peritoneal flexible endoscopy 8 and 24 hours after the colonic operation, by a consultant surgeon who was blinded to both the presence and the allocated location of the of the anastomotic defect.


RESULTS
None of the animals showed signs of illness 48 hours after the intraperitoneal gastrostomy tube placement. More than half of the anastomosis circumference was identified in 60 and 10% of the animals at endoscopy 8 and 24 hours, respectively, after the anastomosis was created. Excessive adhesion formation was observed in all animals, irrespective of AL. The sensitivity and specificity of endoscopy in detecting peritonitis 24 hours after AL were both 60%.


CONCLUSIONS
Peritoneal endoscopy is a safe and simple procedure. Visualization of the peritoneal cavity in the early postoperative course was limited due to adhesion formation. Further studies are needed to clarify the accuracy of the procedure and to address additional methodological concerns.
Surgical Department, Hospital of Southern Jutland, Aabenraa, Denmark.
Sergej
S
Zogovic
Surgical Department, Hospital of South-West Jutland, Esbjerg, Denmark.
Morten
M
Gaarden
Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
Frank Viborg
FV
Mortensen
D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000175:diagnosis*; D000818:Animals; D003106:Colon / Q000601:surgery*; D004195:Disease Models, Animal; D042241:Early Diagnosis; D004724:Endoscopy / Q000379:methods*; D005260:Female; D010529:Peritoneal Cavity; D013552:Swine
Anastomotic leakage; Colorectal anastomosis; Early diagnosis; Peritoneal flexible endoscopy; Randomized trial