医学
乙状结肠镜检查
吻合
荟萃分析
泄漏
结直肠外科
系统回顾
外科
优势比
切除术
结直肠癌
普通外科
梅德林
结肠镜检查
内科学
腹部外科
癌症
环境工程
政治学
法学
工程类
作者
E. J. Williams,Swetha Prabhakaran,Joseph Kong,Stephen Bell,Satish Warrier,Paul J. Simpson,Peter Carne,Chip Farmer
摘要
Abstract Background Anastomotic leak (AL) after colorectal resection leads to increased oncological and non‐oncological, morbidity and mortality. Intra‐operative assessment of a colorectal anastomosis with intra‐operative flexible sigmoidoscopy (IOFS) has become increasingly prevalent and is an alternative to conventional air leak test. It is thought that intra‐operative identification of an AL or anastomotic bleeding (AB) allows for immediate reparative intervention at the time of anastomosis formation itself. We aim to assess the available evidence for the use of IOFS to prevent complications following colorectal resection. Methods Following Preferred Reporting Items for Systematic Reviews and Meta‐analyses guidelines, a systematic review of the literature between January 1980 and June 2020 was performed. Comparative studies assessing IOFS versus conventional air leak test were compared, and outcomes were pooled. Results A total of 4512 articles were assessed, of which eight were found to meet the inclusion criteria. A total of 1792 patients were compared; 884 in the IOFS arm and 908 in the control arm. IOFS was associated with an increase in the rate of positive leak test (odds ratio (OR) 5.21, P > 0.001), a decrease in AL (OR 0.45, P = 0.006) and a decrease in post‐operative AB requiring intervention (OR 0.40, P = 0.037). Conclusion In a non‐randomized meta‐analysis, IOFS increases the likelihood of identifying an anastomotic defect or bleeding intra‐operatively. This allows for immediate intervention that decreases the rate of AL and AB. This adds impetus for performing routine IOFS after a left‐sided colorectal resection with anastomosis and highlights the need for randomized controlled trial to confirm the finding.
科研通智能强力驱动
Strongly Powered by AbleSci AI