Review of Colonic Anastomotic Leakage and Prevention Methods (original) (raw)
Related papers
Colonic Anastomotic Leak: Risk Factors, Diagnosis, and Treatment
Journal of The American College of Surgeons, 2009
Anastomotic dehiscence is one of the most dreaded complications of operations of the large intestine. Breakdown of an anastomosis results in increased morbidity and mortality and adversely affects length of stay, cost, and cancer recurrence. Reported rates of anastomotic dehiscence vary between 1% and 30%, although experienced colorectal surgeons often quote 3% to 6% as an acceptable overall leakage rate(Table 1). 1 Despite a paucity of prospective randomized data, intuitively it would appear that emergent operations are at greater risk for anastomotic breakdown than those procedures performed electively. Confounding the issue is that there are differing opinions as to what risk factors have been proved to predict anastomotic dehiscence. The aim of this review is to examine the currently identified risk factors contributing to intestinal anastomotic breakdown and delineate methods of diagnosis and treatment of this universally dreaded complication.
Colorectal Anastomotic Leaks: A Brief Review of Current Literature
World Journal of Colorectal Surgery, 2015
Colorectal anastomotic leaks are considered problematic complications after colorectal surgery. Anastomotic leaks result increased rates of patient morbidity, mortality (6%-22%), hospitalization loads, and depletion in healthcare resources. The overall percentage of anastomotic leaks after colorectal procedures is approximately 9% with an increasing rate when the anastomosis is closer to the anal verge. Most incidents of anastomotic leaks are difficult to predict, since they manifest with short notice as fever, sepsis, and fecal fistulae. Anastomotic leaks still occur despite the continuous efforts to establish the best structures and techniques for diagnosis, management and treatment. Many attempts are being made to enhance the healthcare systems in regards to dealing with anastomotic leaks and other colorectal surgery complications. New anastomotic procedures and risk assessments should improve incidence of anastomotic leak and early detection. Additionally future studies could emphasis on protection of the anastomosis when leakage occur. In this brief review, we examine the most common risk factors and their prevalence, preventive measures, diagnostic modalities, and treatment patterns for leak management. Although surgical procedures in colorectal surgery have evolved expansively over the last decades, significant improvements in colorectal postoperative outcomes especially, anastomotic leaks, are not yet observed yet. This suggests that the true pathogenesis of leaks remains covert and requires further research. Cooperative efforts should be made regarding the proper diagnosis and management of anastomotic leaks. The technique of performing anastomosis remains at the judgment of surgeons and depends mainly on knowledge, patient status and the operative settings, rather than any verification of one techniques superiority over another.
How to Prevent Anastomotic Leak in Colorectal Surgery? A Systematic Review
Annals of Coloproctology
Anastomosis leakage (AL) after colorectal surgery is an embarrassing problem. It is associated with poor consequence. This review aims to summarize published evidence on prevention of AL after colorectal surgery and provide recommendations according to the Oxford Centre for Evidence-Based Medicine. We conducted bibliographic research on January 15, 2020, of PubMed, Cochrane Library, Embase, Scopus, and Google Scholar. We retained meta-analysis, reviews, and randomized clinical trials. We concluded that mechanical bowel preparation did not reduce AL. It seems that oral antibiotic or oral antibiotic with mechanical bowel preparation could reduce the risk of AL. The surgical approach did not affect the AL rate. The low ligation of the inferior mesenteric artery could reduce the AL rate. The mechanical anastomosis is superior to handsewn anastomosis only in case of right colectomies, with similar results in rectal surgery between the 2 anastomosis techniques. In the case of right colect...
Emerging Trends in the Etiology, Prevention, and Treatment of Gastrointestinal Anastomotic Leakage
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2016
Anastomotic leaks represent one of the most alarming complications following any gastrointestinal anastomosis due to the substantial effects on post-operative morbidity and mortality of the patient with long-lasting effects on the functional and oncologic outcomes. There is a lack of consensus related to the definition of an anastomotic leak, with a variety of options for prevention and management. A number of patient-related and technical risk factors have been found to be associated with the development of an anastomotic leak and have inspired the development of various preventative measures and technologies. The International Multispecialty Anastomotic Leak Global Improvement Exchange group was convened to establish a consensus on the definition of an anastomotic leak as well as to discuss the various diagnostic, preventative, and management measures currently available.
2014
This study aims to increase knowledge of colorectal anastomotic leakage by performing an incidence study and risk factor analysis with new potential risk factors in a Dutch tertiary referral center. Methods All patients whom received a primary colorectal anastomosis between 1997 and 2007 were selected by means of operation codes. Patient records were studied for population description and risk factor analysis. Results In total 739 patients were included. Anastomotic leakage (AL) occurred in 64 (8.7 %) patients of whom nine (14.1 %) died. Median interval between operation and diagnosis was 8 days. The risk for AL was higher as the anastomoses were constructed more distally (p=0.019). Univariate analysis showed duration of surgery (p=0.038), BMI (p=0.001), time of surgery (p=0.029), prophylactic drainage (p=0.006) and time under anesthesia (p=0.012) to be associated to AL. Multivariate analysis showed BMI greater than 30 kg/m 2 (p=0.006, OR 2.6 CI 1.3-5.2) and "after hours" construction of an anastomosis (p=0.030, OR 2.2 CI 1.1-4.5) to be independent risk factors. Conclusion BMI greater than 30 kg/m 2 and "after hours" construction of an anastomosis were independent risk factors for colorectal anastomotic leakage.
How to reduce anastomotic leakage in colorectal surgery—report from German expert meeting
Langenbeck's Archives of Surgery, 2020
Aims Anastomotic leakage is one of the most worrisome complications in colorectal surgery. An expert meeting was organized to discuss and find a consensus on various aspects of the surgical management of colorectal disease with a possible impact on anastomotic leakage. Methods A three-step Delphi-method was used to find consensus recommendations. Results Strong consensus was achieved for the use of mechanical bowel preparation and oral antibiotics prior to colorectal resections, the abundance of non-selective NSAIDs, the preoperative treatment of severe iron deficiency anemia, and for attempting to improve the patients' general performance in the case of frailty. Concerning technical aspects of rectal resection, there was a strong consensus in regard to routinely mobilizing the splenic flexure, to dividing the inferior mesenteric vein, and to using air leak tests to check anastomotic integrity. There was also a strong consensus on not to oversew the stapled anastomoses routinely, to use protective ileostomies for low rectal and intersphincteric, but not for high-rectal anastomoses. Furthermore, a consensus was reached in regard to using CT-scans with rectal contrast enema to evaluate suspected anastomotic leakage as well as measuring C-reactive protein routinely to monitor the postoperative course after colorectal resections. No consensus was found concerning the indication and technique for testing bowel perfusion, the routine use of endoscopy to check the integrity of the anastomosis, the placement of transanal drains for rectal anastomoses and the management of anastomotic leakage with peritonitis. Conclusion Consensus could be found for several practice details in the perioperative management in colorectal surgery that might have an influence on anastomotic leakage. Keywords Delphi method. Consensus conference. Anastomotic failure. Leak rate Anastomotic leakage (AL) is still one of the most worrisome complications in colorectal surgery with an incidence of up to
The management and outcome of anastomotic leaks in colorectal surgery
Colorectal Disease, 2008
Purpose Anastomotic leaks in colorectal surgery are associated with significant morbidity and mortality and may result in poor functional and oncological outcomes. Diagnostic difficulties may delay identification and appropriate management of leaks. The aim of this study was to look at the diagnosis, clinical management and outcomes of anastamotic leaks in our department. Method A retrospective audit and case note review of all patients who underwent the formation of a colorectal anastomosis between January 1996 and December 2002 (n = 1421) was performed. An anastomotic leak was defined as sepsis identified to have arisen from an anastomosis that subsequently required surgery, radiological drainage or intravenous antibiotics. Forty-one patients (25 male, 16 female) with a median age of 60 years (range 7-89 years) were identified as having suffered an anastomotic leak. Results The median time to diagnosis of an anastomotic leak following surgery was 7 days (range 3-29). At re-operation, 21 patients (51%) underwent formation of a stoma, and any who required the anastomosis to be formally taken down have been left with a 'permanent' stoma. Currently only four of 12 patients (33%) who required a stoma for an anastomotic leak following anterior resection have undergone stoma reversal. Eleven of 16 patients (69%) who had received a stoma following another colorectal procedure had undergone stoma reversal. The mortality associated with an anastamotic leak in this series was 5% (n = 2). Conclusion Although anastomotic leaks following colorectal surgery are associated with significant morbidity and stoma formation, early and aggressive management should result in a low overall mortality. If an anastomosis is taken down following an anastomotic leak after anterior resection, this will usually result in a 'permanent' stoma.
Anastomotic Leak after Colorectal Surgery. Our Experience in three Years
Albanian Journal of Trauma and Emergency Surgery
Background: One of the most severe complication after intestinal resection, often with catastrophic consequence for the patient is leakage from the anastomosis. The severity of complications after anastomotic leak may range from a small localized peritonitis or abscess formation without sepsis, to a development of a four quadrant peritonitis with septic shock. Until now despite the seriousness of this complications, the cause of anastomotic leakage are not yet definitively clear. Aim: The aim of this study is to submit our experience in treatment of patients with anastomotic leakage after intestinal resection and their outcome. Materials and Methods: The study included 63 patients with colorectal cancer operated in the Department of Surgery at the Clinical Hospital of Tetova. In all patients intestinal resection with end to end anastomosis was performed. Conclusions: Anastomotic leak after large bowel resection is a very serious complication with a great impact on patient’s morbidit...
Management of colorectal anastomotic leakage: differences between salvage and anastomotic takedown
The American Journal of Surgery, 2012
BACKGROUND: The aim of this study was to evaluate and compare the morbidity associated with 2 strategies of treatment of colorectal anastomotic leakage: surgical drainage of anastomosis with loop ileostomy versus anastomotic takedown. METHODS: An observational study of patients operated on for ileocolic or colorectal anastomotic leakage between 2001 and 2009. Patients were classified into 2 groups: group 1, salvage of the anastomosis, and group 2, anastomotic takedown. Mortality and morbidity were assessed. Morbidity and mortality of bowel restoration were also evaluated. RESULTS: Thirty-nine patients were included into group 1 and 54 into group 2. Mortality was 15% for group 1 and 37% for group 2 (P ϭ .022). The rate of patients suitable for stoma reversal was 91% for loop ileostomy and 38% for end stoma (P Ͻ .001). Morbidity was 18% after loop ileostomy closure and 71% after end stoma reversal (P ϭ .021). Hospitalization was 10 days and 21 days, respectively (P ϭ .009). There was no mortality. CONCLUSIONS: Salvage of anastomosis with loop ileostomy is an effective strategy to control peritoneal sepsis for colorectal anastomotic leakage.