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

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.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%.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.Colon surgery often requires a resection of part of the colon with a subsequent anastomosis to reestablish continuity. The prevalence of intraperitoneal anastomotic leak has been reported between 0.5% to 30%, but is generally between 2% and 5% in the modern literature [1]. The importance of avoiding clinically evident leaks is reflected in a mortality rate 3 to 13 times higher in the population that leaks versus those with an uncomplicated course [2,3]. Despite a long history of colonic anastomosis and associated literature, the more recent advent of the stapled anastomosis brought with it intraoperative testing.Despite a relative paucity of literature specifically centered on intraoperative anastomosis testing, the practice of intraoperative testing of new anastomosis in the distal colon has become standard. A variety of techniques exist, with no literature comparing methods, fr