The amount of tension is double-checked, and a second colonoscopy is performed to ensure the absence of leaks or bleeding in the anastomotic ring. We fill the pelvis with saline solution and inject air through the colonoscope into the bowel lumen. Any leak should be repaired immediately by sutures placed intracorporeally. The clamps on the colon that were left in place during the resection are removed after the colonoscopy is completed.

After we ensure the absence of leaks, the entire cavity, and particularly the trocars are irrigated with Betadine solution, we aspirate all the solution, and a 10 mm flat Jackson-Pratt drain is then placed in the pelvis and brought out through the left lower quadrant trocar. All trocar larger than 10 mm should be closed using 0 Vicryl and a Carter-Thomason suture passer. The entire abdominal cavity is reinspected; all Betadine is washed free with normal saline, and the peritoneal cavity is suctioned dry. The patient is placed in the slight reverse Trendelemburg position, and the abdomen is deinsufflated; after the trocars are removed, all ports sites are immediately closed. The subcutaneous tissue is irrigated thoroughly with Betadine solution and closed; the skin is closed with staples or sutures in a subcuticular fashion and Steri-strips. In cases of anastomosis with high risk of dehiscence, such as difficulty performing anastomosis, previous radiation, leaks repaired intraoperatively, or other entities, we recommend the construction of a protective ileostomy .