Detection of Anastomotic Leakage Following Elective Colonic Surgery: Results of the Prospective Biomarkers and Anastomotic Leakage (BALL) Study

Background. Anastomotic leakage (AL) remains one of the serious complications after colonic surgery. Method. A prospective interventional study to assess a modified technique of creating the ileocolic, colic-colic, and colorectal side-to-side anastomoses using a circular stapler. The primary endpoint was to evaluate the safety and efficacy of this technique in the reduction of AL. Computed tomography scan was performed when AL was clinically suspected. Result. One hundred and forty-five patients who underwent colonic resection between January 2015 and August 2018 were included. One patient underwent surgery for severe inflammatory bowel disease, and the others underwent surgery for colonic cancer. The procedures were open surgeries, including right hemicolectomy (n = 79 [54.5%]), left hemicolectomy (n = 29 [20%]), sigmoidectomy (n = 30 [20.7%]), and transverse colectomy (n = 7 [4.8%]). In 23 patients with ascending colonic obstruction, emergency right colectomy with primary anastomosis was performed. Two surgeons performed the operations (52.4% and 47.6%, respectively), and intraoperative blood loss was 50 to 100 mL. The operative time was 160 to 240 minutes. There was no mortality postoperatively, and 26 (17.9%) patients developed complications. One patient who underwent transverse colonic cancer resection developed a clinical AL (0.7%). After ileostomy, the patient was discharged with no other serious complication. The median of postoperative hospital stay was 8 days (range = 5-18 days). Conclusion. This modified technique is a safe and efficient method for anastomotic configuration in colonic surgery.

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Effect of epidural anesthesia on anastomotic leakage in colonic surgery: experimental study

Turkish Journal of Trauma and Emergency Surgery ◽

10.5505/tjtes.2012.67044 ◽

2012 ◽

Vol 18 (1) ◽

pp. 5-10 ◽

Cited By ~ 3

Author(s):

Tayfun Adanir ◽

Murat Aksun ◽

Gulsah Yilmaz Karaoren ◽

Turker Karabuga ◽

Okay Nazli ◽

...

Keyword(s):

Experimental Study ◽

Anastomotic Leakage ◽

Epidural Anesthesia ◽

Colonic Surgery

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Management and outcome of anastomotic leakage after colonic surgery

Colorectal Disease ◽

10.1111/j.1463-1318.2009.02152.x ◽

2009 ◽

Vol 12 (10Online) ◽

pp. e216-e223 ◽

Cited By ~ 20

Author(s):

A. Rickert ◽

F. Willeke ◽

P. Kienle ◽

S. Post

Keyword(s):

Anastomotic Leakage ◽

Colonic Surgery

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Beware of false-negative CT scan for anastomotic leakage after colonic surgery

International Journal of Colorectal Disease ◽

10.1007/s00384-013-1815-5 ◽

2013 ◽

Vol 29 (4) ◽

pp. 445-451 ◽

Cited By ~ 16

Author(s):

Verena N. N. Kornmann ◽

Bert van Ramshorst ◽

Anke B. Smits ◽

Thomas L. Bollen ◽

Djamila Boerma

Keyword(s):

Ct Scan ◽

Anastomotic Leakage ◽

False Negative ◽

Colonic Surgery

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Prevention of Anastomotic Leakage in Colorectal Surgery: Results of a Prospective Randomised Double-Blind Trial of Aprotinin (Trasylol) in Colonic Surgery

Colo-Proctology ◽

10.1007/978-3-642-95439-9_27 ◽

1984 ◽

pp. 153-158

Author(s):

H. L. Young ◽

M. H. Wheeler

Keyword(s):

Colorectal Surgery ◽

Anastomotic Leakage ◽

Colonic Surgery ◽

Double Blind Trial ◽

Double Blind ◽

Blind Trial

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C-reactive protein in drainage fluid as a predictor of anastomotic leakage after elective colorectal resection

Vojnosanitetski pregled ◽

10.2298/vsp141031017k ◽

2016 ◽

Vol 73 (3) ◽

pp. 228-233 ◽

Cited By ~ 1

Author(s):

Zoran Kostic ◽

Damjan Slavkovic ◽

Zoran Mijuskovic ◽

Marina Panisic ◽

Mile Ignjatovic

Keyword(s):

Anastomotic Leakage ◽

Colorectal Resection ◽

Primary Anastomosis ◽

Colorectal Anastomosis ◽

Colonic Surgery ◽

C Reactive Protein ◽

Mean Values ◽

Drainage Fluid ◽

Serial Measurement ◽

Reactive Protein

Background/Aim. C-reactive protein (CRP) is considered to be an indicator of postoperative complications in abdominal surgery. The aim of this study was to determine the significance of serial measurement of CRP in drainage fluid in the detection of anastomotic leakage (AL) in patients with colorectal resection. Methods. CRP values in serum and drainage fluid, respectively, were measured on the first, third, fifth, and seventh postoperative day (POD) in 150 patients with colorectal resection and primary anastomosis. The values obtained were compared between the group of patient without complications of surgical treatment and those with AL. Results. Clinically evident AL was observed in 15 patients - in two (4.2%) patients with left colonic surgery, and 13 (12.6%) patients with colorectal anastomosis. Mean values of CRP were higher in the patients with AL than in the patients without complications, both in serum and drainage fluid, with the most significant differences recorded on the PODs 5 and 7 (p < 0.001). Correlation analysis showed a positive correlation between serum and drainage fluid CRP levels in both groups of patients. Serum and drainage fluid CRP values on the PODs 5 and 7 are most important in the detection of AL. In 80% of patients with CRP values in the drainage fluid of 53 mg/L for the POD 5 and 42 mg/L for the POD 7 AL was observed. The method specificity was 77% for the POD 5, and 83% for the POD 7. All the patients with CRP values in drainage fluid above 108 mg/L on the POD 5 and 93 mg/L on the POD 7 had AL. Conclusion. Serial measurement of CRP in drainage fluid can reliably be used in the detection of AL in patients with colorectal resection. The most significant values obtained on the PODs 5 and 7 were positively correlated with the values registered in serum.

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The frequency of infectious complications between mechanical bowel preparation and no preparation in elective colonic surgery.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.03.3723 ◽

2020 ◽

Vol 27 (03) ◽

pp. 594-600

Author(s):

Sabeen Adil ◽

Faiqa Aslam ◽

Muhammad Usman

Keyword(s):

Surgical Site Infection ◽

Anastomotic Leakage ◽

Bowel Preparation ◽

Mechanical Bowel Preparation ◽

Infectious Complications ◽

Control Group ◽

P Value ◽

Colonic Surgery ◽

Site Infection ◽

Experimental Group

Mechanical bowel preparation (MBP) is the cleansing technique used clean up the large gut using oral cathartic agents like polyethylene glycol, sodium phosphate, sodium Pico sulfate, and magnesium citrate. Objectives: To compare the frequency of infectious complications between mechanical bowel preparation and no preparation in elective colonic surgery. Study Design: Randomized control trial. Setting: OPD or Indoor Surgical unit 5, DHQ Hospital, Faisalabad. Period: 1st January 2017 to 31st Dec 2018. Material & Methods: Patients diagnosed of malignant tumors of colon, appendix or cecum were included in study. Group A: mechanical bowel preparation done according to standard protocols, group B no mechanical bowel preparation was done. All patients were followed regularly for 2 weeks for presence or absence of surgical site infections and anastomotic leakage. Results: In this study, surgical site infection in both groups was compared, it shows that 18.59% (n=37) in Experimental group and 9.55% (n=19) in Control group had SSI while 81.41% (n=162) in Experimental group and 90.45% (n=180) in Control group bad no SSI, p - value was calculated as 0.009 showing a significant difference. Comparison of surgical anastomotic leakage in both groups was done, it shows that 2.51% (n=5) in Experimental group and 1.51% (n=3) in Control group had anastomotic leakage, p - value was calculated as 0.47 showing insignificant difference. Conclusion: We concluded that no mechanical bowel preparation is significantly better than mechanical bowel preparation in elective colonic surgery in terms of post-operative surgical site infection.

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