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. 2007 Aug 2:7:15.
doi: 10.1186/1471-2482-7-15.

The efficacy of intraoperative methylene blue enemas to assess the integrity of a colonic anastomosis

Stanton Smith  1 , William McGeehin, Robert A Kozol, David Giles
Affiliations

The efficacy of intraoperative methylene blue enemas to assess the integrity of a colonic anastomosis

Stanton Smith et al. BMC Surg. .

Abstract

Background: Intraoperative testing of colonic anastomoses is routine in assuring anastamotic integrity. We sought to determine the efficacy of the methylene blue enema (MBE) as an intraoperative test for anastomotic leaks.

Methods: This study is a retrospective review of consecutive colonic operations performed from January 2001 to December 2004 in a community hospital setting by a general surgical group that uses the MBE exclusively. All operations featuring a colonic anastomosis and an intraoperative MBE were studied (n = 229). Intraoperative MBE via a rectal tube was used as the diagnostic test. Intraoperative leak (IOL) rate and clinically significant postoperative leak (POL) rate were the outcome measures.

Results: The IOL rate was 4.5% for proximal anastomoses, 8% for distal anastomoses, and 7% of total anastomoses. The POL rate was 3% of anastomosis. There were no other testing methods employed. There were no POLs in cases where an IOL led to concomitant intraoperative repair. POL rate for proximal anastomosis was 0.8% and for distal 3%, for stapled 1% and hand sewn 5%.

Conclusion: MBE IOL rate is comparable to published IOL rates for other methods of intraoperative testing. The MBE can be applied to proximal and distal anastomosis. Patients who were found to have an IOL, and underwent immediate repair, did not develop a clinical POL.

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Figures

Figure 1
Figure 1
MBE Apparatus and Method. A. Apparatus for methylene blue enema. B. Anastomosis with gauze pads beneath: C. Cross sectional view (pelvis).
See this image and copyright information in PMC

References

    1. Nasirkhan MU, Abir F, Longo W, Kozol R. Anastomotic disruption after large bowel resection. World J Gastroenterol. 2006;12:2497–2504. - PMC - PubMed
    1. Matthiessen P, Hallbook O, Andersson M, Rutegard J, Sjodahl R. Risk Factors for anastomotic Leakage after anterior resection of the rectum. Colorectal Disease. 2004;6:462–469. doi: 10.1111/j.1463-1318.2004.00657.x. - DOI - PubMed
    1. Hicks TC, Beck DE, Opelka FG, Timmcke AE. Complications of Colon & Rectal Surgery. 1. Chapter 6. Lippincott Williams & Wilkins; 1996.
    1. Ovnat A, Peiser J. Early detection and treatment of leaking gastrojejunostomy following gastric bypass. Isr J Med Sci. 1986;22:556–8. - PubMed
    1. Simmons R, Thevarajah S, Brennan MB, Christos P, Osborne M. Methylene blue dye as an alternative to isosulfan blue dye for sentinel lymph node localization. Ann Surg Oncol. 2003;10:242–247. doi: 10.1245/ASO.2003.04.021. - DOI - PubMed