Management of postoperative bleeding after laparoscopic left colectomy

Besson, R; Christidis, Christos; Denet, Christine; Bruyns, Laurence; Levard, H; Gayet, Brice; Fuks, David; Perniceni, Thierry

doi:10.1007/s00384-016-2612-8

Cited by 18 publications

(23 citation statements)

References 17 publications

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“…Anastomotic bleeding can present as a severe bleed in approximately 1% of patients [47], and a single significant episode in up to 6% of patients [48, 49]. With the considerations of preserving the anastomosis and achieving safe endoscopy due to active bleeding, management can be challenging.…”

Section: Resultsmentioning

confidence: 99%

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Early anastomotic complications in colorectal surgery: a systematic review of techniques for endoscopic salvage

et al. 2019

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BackgroundAnastomotic complications following colorectal surgery are associated with significant morbidity and mortality. For patients in whom systemic sepsis is absent or well controlled, minimal access techniques, such as endoscopic therapies, are being increasingly employed to reduce the morbidity of surgical re-intervention. In this review, we aim to assess the utility of endoscopic management in the acute setting of colorectal anastomotic complications, focusing on anastomotic leak.MethodA literature search was performed for published full text articles using the PubMed, Cochrane and Scopus databases using the search criteria string “colorectal anastomotic (“leak” OR “bleed”), “endoscopy”, endoscopic management”. Additional papers were detected by scanning the references of relevant papers. Data were extracted from each study by two authors onto a dedicated pro-forma. Given the nature of the data extracted, no meta-analysis was performed.ResultsA total of 89 papers were identified, 16 of which were included in this review; an additional 14 papers were obtained from reference searches. In patients who are not physiologically compromised, there are promising data regarding the salvage rate of stents, over-the-scope endoscopic clips, vacuum therapy and fibrin glue in the early management of colorectal anastomotic leak. There is no consensus regarding the optimal approach, and data to assist the physician in patient selection are lacking. Whilst data on salvage (i.e. healing and avoidance of surgery) are well understood, no data on functional outcomes are reported.ConclusionEndoscopic therapy in the management of stable patients with colorectal anastomotic leaks appears safe and in selected patients is associated with high rates of technical success. Challenges remain in selecting the most appropriate strategy, patient selection, and understanding the functional and long-term sequelae of this approach. Further evidence from large prospective cohort studies are needed to further evaluate the role of these novel strategies.

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Section: Resultsmentioning

confidence: 99%

“…Besson et al reported their case series of 729 patients undergoing either a laparoscopic or open elective left hemicolectomy over a 9-year time frame [48]. Post-operative bleeding was experienced in 6.4% of patients, of which 97.8% had a stapled anastomosis.…”

Section: Resultsmentioning

confidence: 99%

Early anastomotic complications in colorectal surgery: a systematic review of techniques for endoscopic salvage

et al. 2019

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“…AB has been reported to occur in 6% of patients following left‐sided colonic resections. Although patients can be managed conservatively, some will require re‐intervention with endoscopy, interventional radiology or surgery with significantly increased morbidity and mortality .…”

Section: Introductionmentioning

confidence: 99%

Does intra‐operative flexible endoscopy reduce anastomotic complications following left‐sided colonic resections? A systematic review and meta‐analysis

et al. 2019

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Aim Postoperative anastomotic leakage (AL) or bleeding (AB) significantly impacts on patient outcome following colorectal resection. To minimize such complications, surgeons can utilize different techniques perioperatively to assess anastomotic integrity. We aim to assess published anastomotic complication rates following left‐sided colonic resection, comparing the use of intra‐operative flexible endoscopy (FE) against conventional tests used to assess anastomotic integrity. Methods PubMed/MEDLINE and Embase online databases were searched for non‐randomized and randomized case–control studies that investigated postoperative AL and/or AB rates in left‐sided colonic resections, comparing intra‐operative FE against conventional tests. Data from eligible studies were pooled, and a meta‐analysis using Review Manager 5.3 software was performed to assess for differences in AL and AB rates. Results Data from six studies were analysed to assess the impact of FE on postoperative AL and AB rates (1084 and 751 patients respectively). Use of FE was associated with reduced postoperative AL and AB rates, from 6.9% to 3.5% and 5.8% to 2.4% respectively. Odds ratios favoured intra‐operative FE: 0.37 (95% CI 0.21–0.68, P = 0.001) for AL and 0.35 (95% CI 0.15–0.82, P = 0.02) for AB. Conclusion This meta‐analysis showed that the use of intra‐operative FE is associated with a reduced rate of postoperative AL and AB, compared to conventional anastomotic testing methods.

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“…Nevertheless, complications such as anastomotic leak and anastomotic bleeding still occur. Fortunately as well as the surgical technique also the possibilities and the modality 'to successfully treat even the most serious post-operative complications are definitely improved (2,3).…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Treatment of Anastomotic Bleeding in Laparoscopic Colorectal Surgery

Mari¹,

Costanzi²,

Crippa³

et al. 2019

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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.

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Management of postoperative bleeding after laparoscopic left colectomy

Cited by 18 publications

References 17 publications

Early anastomotic complications in colorectal surgery: a systematic review of techniques for endoscopic salvage

Early anastomotic complications in colorectal surgery: a systematic review of techniques for endoscopic salvage

Does intra‐operative flexible endoscopy reduce anastomotic complications following left‐sided colonic resections? A systematic review and meta‐analysis

Endoscopic Treatment of Anastomotic Bleeding in Laparoscopic Colorectal Surgery

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