Staple line haemorrhage following laparoscopic left-sided colorectal resections may be more common when the inferior mesenteric artery is preserved

Abstract

Background: Anastomotic bleeding following stapled left-sided colorectal resections is uncommon. There have been few reports on the incidence, severity, management and outcome of such stapled line haemorrhage in the literature. Here, we report our experience of anastomotic bleeding from a stapled anastomosis in laparoscopic left-sided colorectal surgery.

Methods: Data were collected prospectively on all patients undergoing laparoscopic colorectal surgery from 2003. Patients who had a left-sided stapled anastomosis requiring intervention for staple line haemorrhage were studied. Patients who underwent laparoscopic surgery for benign colorectal disease were compared with those who underwent laparoscopic surgery for a malignant condition. Risk factors for bleeding, management and outcome are reported.

Results: Over a 5-year period, 143 patients underwent laparoscopic left-sided colorectal surgery, 72 for benign disease and 71 for a malignant condition. Postoperative anastomotic bleeding occurred in six patients (4%). All were in the benign pathology group, and all had preservation of the inferior mesenteric artery during surgery. None of the patients required operative intervention for staple line haemorrhage.

Conclusions: Anastomotic bleeding from a stapled anastomosis in laparoscopic left-sided colorectal surgery is an infrequent complication and it may be more common with preservation of the inferior mesenteric artery. In the majority, bleeding is self limiting and will settle with nonoperative means. Endoscopic procedures may be useful for confirmation of bleeding and for therapeutic intervention, and may avoid the need for surgical intervention.