Annals of Coloproctology

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Original Article

Complications

Bedside endoscopic inspection of colorectal anastomoses in the early postoperative period: a 2-center prospective feasibility study: David J. Nijssen, Roel Hompes, Jurriaan Tuynman, Jimme K. Wiggers, Willem A. Bemelman, Saidah Sahid, James Kinross, Wytze Laméris; Ann Coloproctol. 2025;41(2):127-135. Published online April 14, 2025; DOI: https://doi.org/10.3393/ac.2024.00584.0083

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Purpose
Early diagnosis of anastomotic leakage (AL) after colorectal surgery can reduce severe postoperative morbidity and ensure successful treatment. This study evaluated the feasibility of bedside endoscopic inspection of the anastomosis early postoperatively using a point-of-care digital rectoscope.
Methods
This prospective study was conducted at 2 tertiary centers. Patients who underwent minimally invasive or open sphincter-preserving surgery with creation of a colorectal or coloanal anastomosis were included. Data were collected from December 2022 to October 2023. Bedside anastomotic inspections were performed postoperative day (POD) 3 to 5 using a point-of-care digital rectoscope. The primary outcome was feasibility, defined as adequate clinical assessment of the anastomosis during bedside inspection. Secondary outcomes included patient tolerability, efficacy compared to other diagnostic methods, and clinical outcomes during 90 days of follow-up.
Results
In total, 35 patients were included. All bedside anastomotic inspections were carried out successfully. The examination showed complete visibility of the entire anastomosis in 30 patients (85.7%), with minimal discomfort reported by 3 (8.6%). No adverse events were recorded. AL occurred in 6 patients (17.1%), with 3 cases detected during bedside inspections between POD 3 and 5. Two leaks were detected without clinical or biochemical suspicion. Three patients with negative rectoscopy between POD 3 and 5 were later diagnosed with AL: 2 by a computed tomography scan and 1 by a bedside rectoscopy.
Conclusion
Bedside inspection of rectal anastomoses early postoperatively is feasible and tolerable for patients. Routine anastomotic inspections can detect early AL even without clear clinical or biochemical signs.

Citations

Citations to this article as recorded by

Is Chronic Pelvic Sepsis Complicating Low Anterior Resection of Rectal Cancer Preventable?
Elroy Patrick Weledji
Surgeries.2026; 7(1): 9. CrossRef
Routine Endoscopic Evaluation of Colorectal Anastomoses for Early Detection of Anastomotic Leakage (REAL Study): Protocol for a Multicenter Prospective Study
David J. Nijssen, Wytze Laméris, Quentin Denost, Antonino Spinelli, Eloy Espín-Basany, James Kinross, Jurriaan Tuynman, Roel Hompes
Digestive Surgery.2025; 42(4): 185. CrossRef
Diagnostic accuracy of C-reactive protein in detecting anastomotic leakage after minimally invasive rectal cancer surgery
David J. Nijssen, Mark Broekman, Franny Rensink, Gijs Stuart, Ritch T. J. Geitenbeek, Joost Stael, Susan van Dieren, Willem A. Bemelman, Jurriaan Tuynman, Esther C. J. Consten, Roel Hompes, Wytze Laméris, G. J. D. van Acker, T. S. Aukema, H. J. Belgers, F
Surgical Endoscopy.2025;[Epub] CrossRef

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