Early postoperative contrast radiology in the assessment of colorectal anastomotic integrity.

The predictive value and safety of early postoperative radiological assessment of colorectal anastomotic integrity is controversial. In this study, 233 patients with colorectal or left sided colonic anastomoses had water soluble contrast enemas performed in the early postoperative period (mean: day 7 postoperatively, range: days 4-14). A total of 40 radiological leaks were recorded but only 12 of these patients had clinical signs of anastomotic dehiscence. Furthermore, 11 patients who had normal contrast enemas subsequently developed a clinical anastomotic leak. There were therefore 28 (12.0%) false positive and 11 (4.7%) false negative results giving values for the specificity and sensitivity of the radiological investigation of 86.7% and 52.2% respectively. Only 3 patients (1.3%) developed a clinically apparent anastomotic complication following a contrast enema. We conclude that while radiological assessment of distal large bowel anastomoses in the early postoperative period appears to be a safe procedure, it provides little useful clinical information with regard to early postoperative morbidity. Recent work has, however, suggested that radiological anastomotic integrity may be relevant to long term outcome following surgery for colorectal cancer.

RCT Entities:   Population Interventions Outcomes