Use of Novel Colorectal Anastomosis Leak Testers to Assess the Integrity of Left-Sided Colorectal Anastomoses

Background Low colorectal anastomoses carry a high anastomotic leak (AL) rate (up to 20%) and thus are commonly diverted. Much less is known about mid-to-high colorectal anastomosis, which carries a leak rate of 2-4%. The objective of this study was to determine our AL rate after mid-to-high colorectal anastomosis and associated risk factors. Methods A single center retrospective cohort study of patients undergoing left colonic resections with mid-to-high colorectal anastomosis (≥7 cm from the anal verge) from January 2008 to October 2017 was utilized. Main outcome, AL, defined as clinical suspicion supported by radiological or intraoperative findings, was calculated and risk factors assessed using multivariable logistic regression analysis. Results 977 patients were included; 487 (49.9%) were male, with a mean age of 59.8 (+/−12.1) years. Mean BMI was 27.5 (+/−5.5) kg/m2. Diverticular disease (67.5%), malignancy (17.4%), and inflammatory bowel disease (2.2%) were the main indications for resection. Mean length of stay was 6.7 (+/−4.5) days. 455 (46.8%) colonic resections were performed by laparoscopy, 283 (29.1%) by hand assisted surgery, 219 (22.5%) by laparotomy, and 16 (1.6%) by robotics. Majority of patients had complete donuts (99.6%) and a negative air leak test (97.7%). 149 patients (15.3%) underwent construction of a diverting stoma. The overall AL rate was 2.1% (n = 20). Increased BMI (>30 kg/m2), P = .02, was an independent risk factor for AL and a trend observed for positive air leak tests ( P = .05), with other factors failing to achieve statistical significance. Conclusions Patients with mid-to-high colorectal anastomosis have a 2% AL risk. Increased BMI was a risk factor for AL.

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Bronchoperitoneal and Enterocutaneous Fistula Development Following a Colorectal Anastomosis Leak

Cureus ◽

10.7759/cureus.6277 ◽

2019 ◽

Author(s):

Peter A Ebeling ◽

Jacob Malmquist ◽

Katherine Beale ◽

Deborah L Mueller ◽

Jason Kempenich

Keyword(s):

Enterocutaneous Fistula ◽

Colorectal Anastomosis ◽

Anastomosis Leak

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Colorectal Anastomosis Leak: Rate , Risk Factors and Outcome in a Tertiary Teaching Hospital, Addis Ababa Ethiopia, a Five Year Retrospective Study

Ethiopian Journal of Health Sciences ◽

10.4314/ejhs.v29i6.14 ◽

1970 ◽

Vol 29 (6) ◽

Author(s):

Gutema Wako ◽

Henok Teshome ◽

Engida Abebe

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Retrospective Study ◽

Colorectal Surgery ◽

Logistic Regression Model ◽

Addis Ababa ◽

Colorectal Anastomosis ◽

Multivariate Logistic Regression Model ◽

Multivariate Logistic Regression ◽

Anastomosis Leak

BACKGROUND: Anastomotic leakage is a morbid and potentially fatal complication of colorectal surgery. Determination of perioperative risk factors for colorectal anastomosis leak helps to identify patients requiring increased postoperative surveillance.METHODS: Institution based retrospective study was done to determine colorectal anastomosis leak rate and risk factors associated with it at a teaching hospital in Addis Ababa Ethiopia. Patients operated from January 2013 to December 2017 G.C were included. Univariate analysis followed by a multivariate logistic regression model was used to determine the influence of patient factors and operative events on postoperative anastomotic leakage.RESULTS: Inclusion criteria were met by 221 patients. Mean age of patients was 46.44(SD=19.1) with range of 1 to 85 years. Male accounted to 166 (74.8%) of the patients. Anastomotic leakage occurred in 12 (5.2%) of the patients. Mean time to diagnosis was 9.55 days (95% CI, 7.2-11.8) after surgery. Univariate analyses showed high preoperative level of creatinine, ASA score III and IV, emergency operation, operative time more than three hours, and malignant diseases were associated with colorectal anastomosisleak. Multivariate logistic regression model failed to show an association. Colorectal anastomosis leak increased the inpatient mortality rate by 50%. Median length of hospitalization in colorectal anastomosis leak group was 27.5 days, versus 7 days in patients without leak.CONCLUSION: Colorectal anastomosis leak remains common problem after colorectal surgery resulting significant post-operative mortality and morbidity.

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REINFORCEMENT OF STAPLE LINE OF COLORECTAL ANASTOMOSIS AS A METHOD OF LEAKEAGE PREVENTION

Koloproktologia ◽

10.33878/2073-7556-2018-0-4-16-24 ◽

2018 ◽

pp. 16-24 ◽

Cited By ~ 1

Author(s):

A. A. Balkarov ◽

E. G. Rybakov ◽

A. A. Ponomarenko ◽

M. V. Alekseev ◽

V. N. Kashnikov

Keyword(s):

Anastomotic Leakage ◽

Anterior Resection ◽

Low Anterior Resection ◽

Staple Line ◽

Colorectal Anastomosis ◽

Main Group ◽

Leakage Rate ◽

Control Group ◽

Colorectal Anastomoses ◽

Anastomotic Leakage Rate

AIM: to decrease anastomotic leakage rate using transanal and transabdominal reinforcing sutures of staple line of colorectal anastomosis. PATIENTS AND METHODS: a prospective randomized trial is started. The main group included patients which underwent anterior or low anterior resection of the rectum with reinforcing of the staple line of colorectal anastomosis using reinforcing sutures on 2, 4, 6, 8, 10 and 12 by conventional dial. The control group consisted of patients without reinforcing of the anastomosis line. RESULTS: from November 2017 to October 2018, 127 patients underwent anterior or low anterior resection of the rectum, 80 of them were included in the study,six were excluded from the study after surgery. Among these 74 patients 40 (54.0 %) were females, mean age was 63.0± 11.0 years. Forty patients consisted the main group, 34 - control. The anastomotic leakage rate in the main group was 7% (3/40), in the control - was 26 % (9/34) (p=0.06). The clinical anastomotic leakage rate in the main group was 3 % (1/40), in the control group - 21 % (7/34) (p=0.03). The anastomotic leakage rate in the main group, after anterior resection of the rectum was 13 % (2/15), in the control - 0 % (0/8) (p=0.8). After low anterior resection the anastomotic leakage rate in the main group was 4 % (1/25), in the control - 35 % (9/26) (p=0.016). Multivariate analysis of risk factors of anastomotic leakage significance associated with male gender (OR 6.88, CI 1,32-of 35.9, p=0,022), positive bubble test (OR 6.26, CI of 1.22-32,2, p=0.028), absence of reinforcing of the anastomosis (OR 4.39, CI 0,96-20,12, p=0,056). CONCLUSION: the reinforcing of colorectal anastomoses decreases anastomotic leakage rate after low anterior resection.

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Routine Drainage of Colorectal Anastomoses: An Evidence-Based Review of the Current Literature

Gastroenterology Research and Practice ◽

10.1155/2017/6253898 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 8

Author(s):

Sameh Hany Emile ◽

Tito M. Abd El-Hamed

Keyword(s):

Current Literature ◽

Controlled Trial ◽

Cochrane Review ◽

Colorectal Anastomosis ◽

Routine Practice ◽

Colorectal Anastomoses ◽

Prophylactic Drainage ◽

Retrospective Cohort Studies ◽

Grade Ii ◽

Meta Analyses

Background. The use of prophylactic drainage after colorectal anastomoses has been long debated. This report aimed to review the current literature discussing routine drainage of colorectal anastomoses highlighting two opposite perspectives (prodrainage and antidrainage) to demonstrate the clinical utility of prophylactic drainage and its proper indications.Methods. An organized literature search was conducted querying electronic databases and Google Scholar. Articles evaluating the role of routine prophylactic drainage after colorectal anastomosis were included and divided into two categories: articles supporting the use of drains (prodrainage) and articles disputing routine drainage (antidrainage).Results. There were seven systematic reviews and/or meta-analyses, one Cochrane review, one randomized controlled trial, and six prospective or retrospective cohort studies. Six studies supported prophylactic drainage of colorectal anastomoses; the quality of these studies ranged between grade II and IV. Nine studies recommended against the use of prophylactic drainage, six studies were grade I, one was grade II, and two were grade IV.Conclusion. Since level I evidence studies including well-designed randomized trials and meta-analyses recommended against the use of pelvic drainage as a routine practice after colorectal anastomoses, we conclude no significant impact of routine drainage on the risk of anastomotic leakage after colorectal anastomoses.

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Prevention of mechanical colorectal anastomosis leak in colostomy reversal after Hartmann procedure

Endoskopicheskaya khirurgiya ◽

10.17116/endoskop201824321 ◽

2018 ◽

Vol 24 (3) ◽

pp. 21

Author(s):

M. I. Sultanmuradov ◽

V. S. Groshilin ◽

P. V. Tsygankov ◽

G. A. Mrykhin

Keyword(s):

Colorectal Anastomosis ◽

Hartmann Procedure ◽

Colostomy Reversal ◽

Anastomosis Leak

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Colorectal Anastomosis: Factors Influencing Success

Journal of the Royal Society of Medicine ◽

10.1177/014107688107400206 ◽

1981 ◽

Vol 74 (2) ◽

pp. 111-118 ◽

Cited By ~ 39

Author(s):

R E B Tagart

Keyword(s):

Rectal Neoplasms ◽

Antimicrobial Prophylaxis ◽

Colorectal Anastomosis ◽

Suture Line ◽

Presacral Space ◽

Arterial Blood Supply ◽

Colorectal Anastomoses ◽

Arterial Blood ◽

High Efficient ◽

Colon And Rectum

Preservation of the anal sphincters is now consistent with adequate extirpation of the majority of rectal neoplasms. However, there is still a troublesome incidence of leakage through colorectal anastomoses. A number of different factors, working in combination, are responsible for this. Although most problems have been solved, and the mortality is low, the anastomotic leak rate described in the present series, and in the hands of most surgeons, remains high. Efficient suturing without tension, adequate filling and drainage of the presacral space, and antimicrobial prophylaxis effective enough to abolish abdominal wound sepsis, have been applied. The large vessel arterial blood supply to the suture line is good but the microcirculation of the left colon and rectum, upon which suture line healing ultimately depends, is suspect. Reduction of blood viscosity by deliberate lowering of the haemoglobin level before operation has been practised in the hope of improving the microcirculatory flow. The results so far are encouraging and suggest that the method is worth a continued trial.

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The potential effect of biological sealants on colorectal anastomosis healing in experimental research involving severe diabetes

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0357 ◽

2017 ◽

Vol 99 (3) ◽

pp. 189-192 ◽

Cited By ~ 8

Author(s):

K Stergios ◽

K Kontzoglou ◽

V Pergialiotis ◽

LM Korou ◽

M Frountzas ◽

...

Keyword(s):

Colorectal Surgery ◽

Anastomotic Leakage ◽

Colorectal Anastomosis ◽

Surgical Techniques ◽

Anastomotic Dehiscence ◽

Potential Effect ◽

Current Evidence ◽

Diabetic Patients ◽

Colorectal Anastomoses ◽

Fibrin Sealants

Colorectal anastomoses continuous to pose a significant challenge in current surgical practice. Anastomotic leakage remains one of the most frequent and dramatic complications of colorectal surgery, even in centres of high specialisation. Diabetes is a well-established independent factor which results in higher anastomotic leakage rates. Fibrin sealants have been applied in experimental and clinical studies for the prevention of anastomotic dehiscence. However, little is known regarding their impact on diabetic patients. Several fibrin sealants have been proposed as adjunct to standard surgical techniques to prevent leakage from colonic anastomoses following the reversal of temporary colostomies, approved for general haemostasis. This review summarises current advances in colorectal anastomoses and provides evidence that may strengthen the need for tissue sealants in colorectal anastomoses of diabetic patients. We searched Medline (1966–2016) and Scopus (2004–2016) for current evidence in the field. To date, there is no evidence to support the use of fibrin sealants as an adjunct in diabetic patients who undergo colorectal surgery. Experimental animal models with extreme diabetes could be of significant use in the present field and further research is needed prior to application of fibrin sealants in a clinical setting.

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The use of a novel adhesive tissue patch as an aid to anastomotic healing

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2018.0003 ◽

2018 ◽

Vol 100 (3) ◽

pp. 230-234 ◽

Cited By ~ 2

Author(s):

J Trotter ◽

L Onos ◽

C McNaught ◽

M Peter ◽

M Gatt ◽

...

Keyword(s):

Computed Tomography ◽

Pilot Study ◽

Patient Outcomes ◽

Potential Role ◽

Colorectal Anastomosis ◽

Anastomotic Healing ◽

Uneventful Recovery ◽

Colorectal Anastomoses ◽

Handling Characteristics ◽

Postoperative Problems

Introduction One of the most feared complications of colorectal surgery is anastomotic leak. Numerous techniques have been studied in the hope of decreasing leakage. This study was designed to assess the handling characteristics of a novel adhesive tissue patch (TissuePatch™; Tissuemed, Leeds, UK) applied to colorectal anastomoses in a pilot study. This was with a view to assessing its potential role in aiding anastomotic healing in subsequent trials. Methods A patch was applied to colorectal anastomoses after the surgeon had completed the anastomosis and prior to abdominal closure. Handling characteristics and patient outcomes were recorded prospectively. Results Nine patients were recruited before the study was prematurely terminated. In one patient, the patch fell off and in another patient, the surgeon omitted to apply it. Six patients had significant postoperative problems (1 confirmed leak necessitating return to theatre and excision anastomosis, 3 suspicious of leak on computed tomography delaying discharge, 2 perianastomotic collections). One patient had an uneventful recovery. Conclusions Although the handling characteristics of this novel tissue patch were deemed satisfactory, it appears that wrapping a colorectal anastomosis with an adhesive hydrophilic patch has significant deleterious effects on anastomotic healing. This could be a consequence of the creation of a microenvironment between the patch and the anastomosis that impairs healing. Further research is required to better understand the mechanisms involved. At present, the use of such patches on colorectal anastomoses should be discouraged outside the confines of a well monitored trial.

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Intraoperative air testing of colorectal anastomoses

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1106333i ◽

2011 ◽

Vol 139 (5-6) ◽

pp. 333-338 ◽

Cited By ~ 22

Author(s):

Dejan Ivanov ◽

Radovan Cvijanovic ◽

Ljiljana Gvozdenovic

Keyword(s):

Randomized Study ◽

Colorectal Anastomosis ◽

Good Method ◽

Anastomotic Dehiscence ◽

Control Group ◽

Air Bubbles ◽

Air Leak ◽

Exact Test ◽

Colorectal Anastomoses ◽

Leak Testing

Introduction. Intraoperative anastomotic air testing of stapled colorectal anastomosis is performed by filling the pelvis with saline solution and insufflating the rectum with air through a sigmoidoscope. The presence of air bubbles indicates anastomotic leaks which are resolved during surgery. Objective. The aim of this prospective, randomized study was to perform a comparative analysis regarding the number of anastomotic dehiscences in patients checked by air leak testing and in the control group without air testing. Methods. After stapled colorectal anastomosis was performed, patients were randomized into two groups of 30 patients. The first group patients underwent intraoperative anastomotic air testing, whereas in the control group this procedure was not performed. The two groups were matched for age, sex, diagnosis and surgical procedure. Results. Intraoperative air tests were positive in seven cases and anastomotic defects were repaired. After surgery, there were three clinical leaks in this group of patients. In the control group, there were six leaks (Unilateral Fischer?s exact test, p=0.24). The incidence of colorectal anastomotic dehiscences in the study group was lower than in the control group by 50%. However, this finding was not statistically significant in our sample. Conclusion. In our opinion, intraoperative air testing of colorectal anastomosis is a good method for prevention of anastomotic dehiscence.

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