Endoscopic Treatment of Anastomotic Bleeding in Laparoscopic Colorectal Surgery

Abstract

Bleeding from the stapled line is a rare but potentially lethal complication that requires a proper and immediate management. Treatment for stapled anastomotic hemorrhage may be operative or conservative. We report three cases of anastomotic stapled line bleeding after colorectal surgery successfully treated endos-copically. Laparoscopic High Anterior Resection with a trans anal anastomosis according to Knight-Griffen with circular a stapler was performed for adenocarcinoma, rectal endometriosis and diverticular disease. All three patients had major rectal bleeding within 24 hours from surgery. 1 patients had endoscopy before the end of the surgical procedure. Endoscopic wash out with removal of the clots and infiltration of the bleeding sites along the stapled line with Adrenaline 1 : 10000 (2 ml) was performed achieving a good hemostasis. Early endoscopy is a safe and efficient treatment in colorectal anastomotic bleeding.

Delayed Bleeding at Different Anastomotic Sites After Operation for Synchronous Colon and Rectal Carcinoma: A Rare Case Report

“…Anastomotic bleeding is one of the most dangerous postoperative complications of colorectal cancer, and its incidence is reported in the literature as 0.5%-9.6% [4][5][6]. Postoperative anastomotic bleeding usually occurs within 24 hours after the operation [1,7]. The early postoperative anastomotic bleeding is mainly related to insu cient hemostasis during the operation and postoperative circulation uctuation [2].…”

“…So far, the risk factors associated with anastomotic bleeding have not been fully elucidated, making it much more di cult to predict and prevent postoperative anastomotic hemorrhage. Although there was still a lot of debate, some studies believed that intraoperative colonoscopy can help to detect active bleeding and make timely treatment, reducing the probability of postoperative anastomotic bleeding [1,7]. However, intraoperative colonoscopy requires high technical requirements and endoscopy dedicated surgeons or gastroenterologists, making a routine intraoperative colonoscopy di cult to be popularized [1,3].…”

“…Although there was still a lot of debate, some studies believed that intraoperative colonoscopy can help to detect active bleeding and make timely treatment, reducing the probability of postoperative anastomotic bleeding [1,7]. However, intraoperative colonoscopy requires high technical requirements and endoscopy dedicated surgeons or gastroenterologists, making a routine intraoperative colonoscopy di cult to be popularized [1,3]. As a compensation, some surgeons recommended that digital rectal examination and air leakage test should be always performed to preliminarily determine the integrity of the anastomosis, and routinely whole layer interrupted reinforcement sutures after stapled anastomosis might help to reduce the probability of postoperative anastomotic bleeding [1,7].…”

“…Anastomotic bleeding is one of the most common anastomosis related complications after gastrointestinal reconstruction surgery. Although the incidence of postoperative anastomotic bleeding is relatively low as reported in the literature, it increases the di culty of treatment, prolongs the length of hospital stay, raises the hospitalization cost of patients, and is life-threatening in serious cases [1,2].…”

Achievement of haemostasis following a double‐stapled (Knight–Griffen) anastomosis using the transanal endoscopic operating system – a video vignette

“…The use of endoscopic clips or direct injection of sclerosing agents guarantees accurate haemostasis. Endoscopic electrocoagulation may also be used to deal with anastomotic haemorrhage .…”