Staple line haemorrhage following laparoscopic left-sided colorectal resections may be more common when the inferior mesenteric artery is preserved

Abstract

Anastomotic bleeding from a stapled anastomosis in laparoscopic left-sided colorectal surgery is an infrequent complication and it may be more common with preservation of the inferior mesenteric artery. In the majority, bleeding is self limiting and will settle with nonoperative means. Endoscopic procedures may be useful for confirmation of bleeding and for therapeutic intervention, and may avoid the need for surgical intervention.

Endoscopic Intraoperative Anastomotic Testing May Avoid Early Gastrointestinal Anastomotic Complications. A Prospective Study

“…Bleeding following gastrointestinal anastomosis is infrequent but may have significant consequences, 24 and it seems to be more common following stapled anastomoses. 13,27 In our experience, endoscopic IOAT was unique because it allowed to pinpoint the bleeding point and to manage it under direct visualization.…”

“…1,23 Anastomotic leakage, bleeding, and stenosis occur with low but still disappointing rates. 24,25 The cause of anastomotic defect is thought to be multifactorial, although an imperfect technique must play some part. Current evaluation methods not including direct visualization of the integrity of the anastomosis are considered to be suboptimal.…”

Incidence and management of anastomotic bleeding after ileocolic anastomosis

“…Most studies on postoperative complications of colon cancer discuss infectious complications and anastomotic dehiscence , but anastomotic bleeding, especially after right colectomy, is only mentioned in case reports or retrospective studies including anastomosis after right, left and total colectomy, or even rectal resection. Bleeding from a specific type of anastomosis is only referred to in studies reviewing the circular staple line in the upper rectum and left colon . In a Cochrane report, only two reviewed studies included postoperative haemorrhage as an end‐point, but LGIB was not reported .…”

Colonoscopy is the first choice for early postoperative rectal anastomotic bleeding

“…The incidence of postoperative colorectal anastomotic bleeding varies from 0.4 to 4% [ 5 , 6 ]. In our study, the incidence of stapled anastomotic bleeding was 0.3%, lower than that reported in previous reports.…”