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Updated: Jul 30, 2025

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Intraoperative Anastomotic Evaluation Methods: Rigid Proctoscopy Versus Flexible Endoscopy.

Cyrus Farzaneh1, William Q Duong1, Stephen Stopenski1

  • 1Division of Colon and Rectal Surgery, Department of Surgery, University of California, Irvine, Orange, California.

The Journal of Surgical Research
|May 14, 2023
PubMed
Summary
This summary is machine-generated.

Flexible sigmoidoscopy (FS) is associated with lower rates of anastomotic leak and organ space infection compared to rigid proctosigmoidoscopy (RP) during colorectal anastomosis evaluation. RP use increases the risk of anastomotic leak.

Keywords:
Colorectal anastomosisFlexible sigmoidoscopyRigid proctosigmoidoscopy

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Area of Science:

  • Colorectal Surgery
  • Surgical Outcomes
  • Endoscopy

Background:

  • Intraoperative evaluation of colorectal anastomoses is crucial for preventing complications.
  • Rigid proctosigmoidoscopy (RP) and flexible sigmoidoscopy (FS) are common endoscopic modalities used for this purpose.
  • The comparative impact of RP versus FS on anastomotic leak (AL) and infection rates is not fully elucidated.

Purpose of the Study:

  • To determine the association between endoscopic modality (RP vs. FS) and the rates of anastomotic leak (AL), organ space infection, and overall infectious complications.
  • To compare the risk of anastomotic complications when using RP versus FS for intraoperative colorectal anastomosis evaluation.

Main Methods:

  • Analysis of the 2012-2018 American College of Surgeons National Surgical Quality Improvement Program database.
  • Inclusion of patients undergoing colorectal anastomosis with intraoperative endoscopic evaluation.
  • Classification into RP and FS groups based on Current Procedural Terminology coding, with multivariable logistic regression for AL prediction.

Main Results:

  • A total of 7100 patients were analyzed; 47.8% underwent RP and 52.2% underwent FS.
  • FS use was associated with significantly lower rates of organ space infection (3.8% vs. 4.8%) and AL (2.9% vs. 3.8%) compared to RP.
  • Multivariate analysis indicated that RP evaluation was independently associated with a higher risk of AL (OR 1.403, P=0.033) compared to FS.

Conclusions:

  • Rigid proctosigmoidoscopy evaluation of colorectal anastomoses is linked to increased rates of anastomotic leak and organ space infection.
  • Flexible sigmoidoscopy appears to be a safer endoscopic modality for intraoperative assessment of colorectal anastomoses.
  • These findings suggest a preference for flexible sigmoidoscopy to minimize anastomotic complications.