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Purpose <p>Despite advances in surgical techniques, anastomotic leakage (AL) remains a serious complication after colorectal surgery. Intraoperative colonoscopy (IOC) has emerged as a technique to detect and potentially reduce AL; however, its routine use remains controversial due to limited evidence.</p> Methods <p>We conducted a systematic literature search of MEDLINE, the Cochrane Library, and Google Scholar through April 2025 to identify studies comparing the anastomosis outcomes between IOC and non-IOC groups in left-sided colorectal surgery. The primary outcome was AL and the secondary outcomes included intraoperative air leakage and anastomotic bleeding. We used a random-effects meta-analysis to calculate the odds ratios (ORs) with 95% confidence intervals (CIs).</p> Results <p>Ten studies involving 3,023 patients were included. IOC significantly reduced AL compared to non-IOC (OR 0.53; 95% CI 0.36–0.79; <i>p</i> = 0.002; number needed to treat = 27). IOC also showed a higher detection rate of intraoperative air leaks (OR, 0.32; 95% CI, 0.11–0.92; <i>p</i> = 0.03). Although not statistically significant, bleeding tended to be lower with IOC. Subgroup analyses showed AL reduction in cases of cancer, rectal surgery, and minimally invasive procedures.</p> Conclusions <p>IOC reduces the intraoperative air leak rates and improves detection, thereby supporting its use in selected colorectal surgeries.</p>

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Impact of intraoperative colonoscopy for anastomosis assessment after left-sided colorectal surgery: a meta-analysis

  • 期刊论文

  • 发表日期：

    2026年3月14日

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  • Suun Sathornviriyapong,
  • Akihisa Matsuda,
  • Hariruk Yodying,
  • Thana Boonsinsukh,
  • Hiroshi Yoshida

摘要

Purpose

Despite advances in surgical techniques, anastomotic leakage (AL) remains a serious complication after colorectal surgery. Intraoperative colonoscopy (IOC) has emerged as a technique to detect and potentially reduce AL; however, its routine use remains controversial due to limited evidence.

Methods

We conducted a systematic literature search of MEDLINE, the Cochrane Library, and Google Scholar through April 2025 to identify studies comparing the anastomosis outcomes between IOC and non-IOC groups in left-sided colorectal surgery. The primary outcome was AL and the secondary outcomes included intraoperative air leakage and anastomotic bleeding. We used a random-effects meta-analysis to calculate the odds ratios (ORs) with 95% confidence intervals (CIs).

Results

Ten studies involving 3,023 patients were included. IOC significantly reduced AL compared to non-IOC (OR 0.53; 95% CI 0.36–0.79; p = 0.002; number needed to treat = 27). IOC also showed a higher detection rate of intraoperative air leaks (OR, 0.32; 95% CI, 0.11–0.92; p = 0.03). Although not statistically significant, bleeding tended to be lower with IOC. Subgroup analyses showed AL reduction in cases of cancer, rectal surgery, and minimally invasive procedures.

Conclusions

IOC reduces the intraoperative air leak rates and improves detection, thereby supporting its use in selected colorectal surgeries.