scholarly journals Bacteriological concentration of peritoneal drainage fluid could make an early diagnosis of anastomotic leakage following rectal resection

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Wei Ge ◽  
Hai-yan Gong ◽  
Yong-quan Xia ◽  
Li-hua Shao ◽  
Han Shen ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Anastomotic Leakage ◽  
Confidence Intervals ◽  
General Surgery ◽  
Ph Value ◽  
Rectal Resection ◽  
Drainage Fluid ◽  
Good Marker ◽  
Peritoneal Drainage ◽  
Auc Value

AbstractTo investigate that the bacteriological concentration and pH value in peritoneal drainage fluid might serve as indicators of early diagnosis of anastomotic leakage following rectal resection. We prospectively analyzed consecutive patients who were treated for rectal diseases with anastomosis at the department of general surgery, the affiliated hospital of Nanjing University Medical School between August 2018 and December 2020. The bacteriological concentration and the pH value in peritoneal drainage fluid were tested on the first, fourth, seventh days postoperatively. A total of 300 consecutive patients underwent rectal resection were tested. 21 patients present with AL and the overall AL rate was 7%. The bacteriological concentration in peritoneal drainage fluid of AL group was significantly higher than that in non-AL group. The AUC value was 0.98 (95% confidence intervals 0.969–1.000) according to the ROC curve. The best cut-off value was 1143/uL. The sensitivity and specificity were 100% and 93.19% respectively. There was no difference of pH value between the AL and non-AL groups. According the results of present study, a high bacteriological concentration in peritoneal drainage fluid is a good marker for predicting and diagnosing AL following rectal resection. However, owing to the limitation of the sample, there was no validation attempt in the study. A large sample study is needed to validate the conclusion.

scholarly journals Bacteriological Concentration of Peritoneal Drainage Fluid Could Make an Early Diagnosis of Anastomotic Leakage Following Rectal Resection

2021 ◽  
Author(s):  
Wei Ge ◽  
Hai-yan Gong ◽  
Yong-quan Xia ◽  
Li-hua Shao ◽  
Han Shen ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Anastomotic Leakage ◽  
Sensitivity And Specificity ◽  
General Surgery ◽  
Ph Value ◽  
Rectal Resection ◽  
Drainage Fluid ◽  
Good Marker ◽  
Peritoneal Drainage ◽  
Auc Value

Abstract Purpose: To investigate that the bacteriological concentration and pH value in peritoneal drainage fluid might serve as indicators of early diagnosis of anastomotic leakage following rectal resection.Methods: We prospectively analyzed consecutive patients who were treated for rectal diseases with anastomotic stoma at the department of general surgery, the affiliated hospital of Nanjing University Medical School between August 2018 and December 2020. The bacteriological concentration and the pH levels in peritoneal drainage fluid were tested on the first, fourth, seventh days postoperatively.Results: A total of 300 consecutive patients underwent rectal resection were tested. 21 patients present with AL and the overall AL rate was 7%. The bacteriological concentration in peritoneal drainage fluid of AL group was significantly higher than that in non-AL group. The AUC value was 0.98 according to the ROC curve. The best cut-off value was 1143/uL and the sensitivity and specificity were 100% and 93.19% respectively. There was no difference of pH value between the AL and non-AL groups. Conclusion: According the results of present study, a high bacteriological concentration in peritoneal drainage fluid is a good marker for predicting and diagnosing AL following rectal resection. The best cut-off value is1143/uL and the sensitivity and specificity are 100% and 93.19% respectively.

Significance of Amylase Monitoring in Peritoneal Drainage Fluid after Splenectomy: A Clinical Analysis of Splenectomy in 167 Patients with Hepatolenticular Degeneration

2020 ◽  
Vol 86 (4) ◽  
pp. 334-340
Author(s):  
Yi Shen ◽  
Binbin Guo ◽  
Laiyong Wang ◽  
Hui Peng ◽  
Jinfang Pan ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Pancreatic Fistula ◽  
Influence Factors ◽  
Fistula Formation ◽  
Physiological Parameter ◽  
Targeted Prevention ◽  
Hepatolenticular Degeneration ◽  
Abdominal Drainage ◽  
Drainage Fluid ◽  
Peritoneal Drainage

Different kinds of complications after splenectomy in hepatolenticular degeneration patients with hypersplenism have been reported in the past decades, but studies on pancreatic fistula and the corresponding targeted prevention and treatment after splenectomy still remain much unexplored. The present work investigated the pathogenic factors of pancreatic fistula after splenectomy and the variation tendency of amylase in drainage fluid, aiming to verify the significance of monitoring amylase in the abdominal drainage fluid in the early diagnosis of pancreatic fistula after splenectomy. One hundred sixty-seven patients with hepatolenticular degeneration and hypersplenism who underwent splenectomy in the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from January 2016 to August 2018 were selected and analyzed. The amylase in the abdominal drainage fluid was monitored routinely after splenectomy. We also conducted the statistics on the incidence of different types of pancreatic fistula and analyzed the influence factors of pancreatic fistula formation. After splenectomy, biochemical fistula occurred in 11 patients (6.6%), grade B fistula in six patients (3.6%), grade C fistula in one patient (0.6%), and the incidence of pancreatic fistula was 4.2 per cent (biochemical fistula excluded). The amylase in the peritoneal drainage fluid was closely concerned with the incidence of pancreatic fistula according to our statistics. Furthermore, by analyzing the different influence factors of pancreatic fistula, Child-Pugh grading of liver function ( P = 0.041), pancreatic texture ( P = 0.029), degree of splenomegaly ( P = 0.003), and operative method ( P = 0.001) were supposed to be closely related to the formation of pancreatic fistula. Monitoring of amylase in peritoneal drainage fluid is regarded as an important physiological parameter in the early diagnosis of pancreatic fistula after splenectomy, which provides effective clinical reference and plays a significant role in preventing the occurrence and development of pancreatic fistula.

Obsidian ASG® Autologous Platelet-Rich Fibrin Matrix and Colorectal Anastomotic Healing: A Preliminary Study

2021 ◽  
Vol 39 ◽  
Author(s):  
Andreas Shamiyeh ◽  
◽  
Bettina Klugsberger ◽  
Carina Aigner ◽  
Wolfgang Schimetta ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Anastomotic Leak ◽  
Colorectal Resection ◽  
Rectal Resection ◽  
Leak Rate ◽  
Anastomotic Healing ◽  
Platelet Rich Fibrin ◽  
Anastomotic Leak Rate ◽  
Fibrin Matrix ◽  
Autologous Platelet

Introduction: Anastomotic leakage (AL) following colorectal resection is a devastating complication affecting morbidity, mortality, and quality of life of patients in the long term. Different tissue sealants and biologic glues were tested showing conflicting results regarding their influence on anastomotic healing and leak prevention. Application of autologous platelet-rich fibrin (Vivostat A/S, Alleroed, Denmark), which acts as a source of angiogenic growth factors and cytokines, showed promising results in an in-vivo porcine model. Herein, we present the first human study of stapled colorectal anastomoses supplemented with an autologous-derived platelet-rich fibrin matrix (Obsidian ASG®, Rivolution GmbH, Rosenheim, Germany and Vivostat A/S, Alleroed, Denmark). Materials and Methods: A retrospective analysis of prospectively accumulated data was performed in two colorectal centers (Linz, Vienna) on patients undergoing left-sided colorectal or coloanal stapled anastomosis between October 2018 and December 2019. The Obsidian ASG® Matrix was applied to the rectal stump, and after closure with the circular stapling device, at the circumference of anastomosis in every single case. Anastomoses were supplemented with intra- and extra-anastomotic application (IAA—intra-anastomotic application developed by Rivolution GmbH, Rosenheim, Germany) of Obsidian ASG® Matrix. The primary endpoints were incidence of perioperative complications and anastomotic leak rate. Results: Two-hundred-sixty-one (138 female) patients underwent left-sided colonic (n=177) or rectal resection (n=84). In 253 (96.9%) cases, a laparoscopic or robotic-assisted approach was used. There were no complications attributable to the intraoperative application of the Obsidian ASG® Matrix. All intraoperative leak tests were negative. Overall, anastomotic leak rate accounted for 2.3% (6/261). AL following colonic and rectal resection was seen in 2.3% (4/177) and 2.4% (2/84), respectively. Complication and leak rate was similar in the two participating centers. Postoperative fever and elevated CRP levels were significantly correlated to AL. There was no significant risk factor for AL on multivariate analysis. Conclusion: Application of an autologous-derived platelet-rich fibrin matrix (Obsidian ASG®) at anastomotic site following colorectal resection is safe and associated with a low rate of anastomotic leakage.

scholarly journals Exploring optimal examination to detect occult anastomotic leakage after rectal resection in patients with diverting stoma

2020 ◽  
Author(s):  
Daichi Kitaguchi ◽  
Tsuyoshi Enomoto ◽  
Yusuke Ohara ◽  
Yohei Owada ◽  
Katsuji Hisakura ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Anastomotic Leakage ◽  
Rectal Resection ◽  
False Negative ◽  
Water Soluble ◽  
Stapled Anastomosis ◽  
Stoma Closure ◽  
Radiological Result ◽  
Diverting Stoma

Abstract Background When considering “early stoma closure”, both standardized inclusion/exclusion criteria and standardized methods to assess anastomosis are necessary to reduce the risk of occult anastomotic leakage (AL). However, in the immediate postoperative period, neither have the incidence and risk factors of occult AL in patients with diverting stoma (DS) been clarified nor have methods to assess anastomosis been standardized. The aim of this study was to elucidate the incidence and risk factors of occult AL in patients who had undergone rectal resection with DS and to evaluate the significance of computed tomography (CT) following water-soluble contrast enema (CE) to detect occult anastomotic leakage. Methods This was a single institutional prospective observational study of patients who had undergone rectal resection with the selective use of DS between May and October 2019. Fifteen patients had undergone CE and CT to assess for AL on postoperative day (POD) 7, and CT was performed just after CE. Univariate analysis was performed to assess the relationship between preoperative variables and the incidence of occult AL on POD 7 Results The incidence of occult AL on postoperative day 7 was 6 of 15 (40%). Hand-sewn anastomosis, compared with stapled anastomosis, was a significant risk factor. Five more cases with occult AL that could not be detected with CE could be detected on CT following CE; CE alone had a 33% false-negative radiological result rate. Conclusions Hand-sewn anastomosis appeared to be a risk factor for occult AL, and CE alone had a high false-negative radiological result rate. When considering the introduction of early stoma closure, stapled anastomosis and CT following CE could be an appropriate inclusion criterion and preoperative examination, respectively.

Diagnostic accuracy of procalcitonin for the early diagnosis of anastomotic leakage after colorectal surgery: a meta‐analysis

2019 ◽  
Vol 90 (5) ◽  
pp. 675-680
Author(s):  
Bruce Su'a ◽  
Senitila Tutone ◽  
Wiremu MacFater ◽  
Ahmed Barazanchi ◽  
Weisi Xia ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Early Diagnosis ◽  
Diagnostic Accuracy ◽  
Anastomotic Leakage ◽  
Meta Analysis

scholarly journals Risk Factors for Anastomotic Leakage after Laparoscopic Rectal Resection

2010 ◽  
Vol 26 (4) ◽  
pp. 265 ◽  
Author(s):  
Dong Hyun Choi ◽  
Jae Kwan Hwang ◽  
Yong Tak Ko ◽  
Han Jeong Jang ◽  
Hyeon Keun Shin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Anastomotic Leakage ◽  
Rectal Resection ◽  
Laparoscopic Rectal Resection

Relationship between multiple numbers of stapler firings during rectal division and anastomotic leakage after laparoscopic rectal resection

2008 ◽  
Vol 23 (7) ◽  
pp. 703-707 ◽  
Author(s):  
Masaaki Ito ◽  
Masanori Sugito ◽  
Akihiro Kobayashi ◽  
Yusuke Nishizawa ◽  
Yoshiyuki Tsunoda ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Rectal Resection ◽  
Laparoscopic Rectal Resection

scholarly journals Application of Mediastinal Drainage Tube in Intrathoracic Esophageal Anastomotic Leakage for Early Diagnosis and Effective Treatment: A Retrospective Study

2020 ◽  
Author(s):  
Hainong Ma ◽  
Xu Song ◽  
Jie Li ◽  
Guofang Zhao
Keyword(s):  
Early Diagnosis ◽  
Anastomotic Leakage ◽  
Esophageal Resection ◽  
Drainage Tube ◽  
Control Group ◽  
Common Symptom ◽  
Pleural Drainage ◽  
Significant Difference ◽  
Mediastinal Drainage ◽  
Almost All

Abstract Background: Intrathoracic esophageal anastomotic leakage (AL) is one of the most fatal complications after esophagectomy. In this study, we tried to place an additional drainage tube in esophagus bed and evaluate its effect in early diagnosis and treatment of AL.Methods: From January 2010 to August 2020, a total of 312 patients, who suffered from esophageal or cardia carcinoma, underwent esophageal resection with intrathoracic esophagogastric anastomosis. Among them, we identified 138 patients with only one pleural drainage tube as “Control Group” and 174 patients with a pleural drainage tube and an additional mediastinal drainage tube (MDT) as “Tube Group”. The incidence of postoperative AL, time to diagnosis, time to recovery, and patient outcome were analyzed.Results: There were no significant differences in the AL rate (P = 0.837) and postoperative pain between two groups. However, in the Tube Group, almost all the patients were definitely diagnosed prior to the appearance of hyperpyrexia, which was regarded as the earliest and most common symptom after AL. Moreover, in the Tube Group, there was significant decrease in the incidence of uncurable fistula, which required re-operation or variable treatments under gastroscopy, when compared to the Control Group (P = 0.032). Finally, patients in the Tube Group were associated with reduced post AL hospital day (P = 0.015) and lower mortality, although there was no significant difference (P = 0.188), than in the Control Group.Conclusions: Placement of a MDT can not prevent the AL, but it is an effective method to diagnose AL earlier and facilitate the fistula healing and patient recovery.

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