Intraoperative colonoscopy for anastomosis assessment in left sided colorectal surgery; does it prevent anastomotic leak?

Background: Anastomotic leak is the most dreaded complication following colorectal surgery. Objective methods of assessing the anastomosis integrity are needed to minimise these catastrophes. Intraoperative colonoscopy allows immediate assessment of anastomosis integrity and possible bleeding from stapler line.
Purpose: The aim of our study was to evaluate the impact of intraoperative colonoscopy in preventing anastomotic leak following left-sided colorectal stapled anastomosis.
Method: A retrospective study was performed in a colorectal center in Malaysia. All patients who underwent laparoscopic and open left-sided colorectal surgery from 2019 till 2020 were included in this study. Demographic details, surgical procedure details and surgical outcome of participants were collected from their medical records. The incidence of anastomotic leak in patients who underwent intraoperative colonoscopy after anastomosis and those did not were compared using Pearson’s Chi Square test.
Results: A total number of 131 patients were enrolled in this study. 62 (47.3 %) patients underwent intraoperative colonoscopy evaluation and 69 (52.7%) patients without it. In the intraoperative colonoscopy group, 4 (6.5%) anastomotic leak were detected intraoperatively and repaired. Out of it 1 patient had postoperative leak. One patient had leak during post operative period despite the intraoperative colonoscopy was normal. In patients without intraoperative colonoscopy, 9 (15.7%) anastomotic leak were detected during the postoperative period. The Pearson Chi-Square test value for the association between performing on table scope and surgery outcome was 4.092 (p=0.043) which is statistically significant.
Conclusion: The rate of anastomosis leak is lower among patients who had intraoperative colonoscopy. The detection of threatened anastomosis through intraoperative colonoscopy allows immediate surgical repair and prevention of potential anastomosis leak postoperatively. Therefore, intraoperative colonoscopy has a positive impact in terms of detection and prevention of postoperative anastomotic leak in left-sided surgical resections with stapled anastomosis.