Anastomotic Troubleshooting

AbstractAnastomotic leak remains a critical and feared complication in colorectal surgery. The development of a leak can be catastrophic for a patient, resulting in overall increased morbidity and mortality. To help mitigate this risk, there are several ways to assess and potentially validate the integrity of a new anastomosis to give the patient the best chance of avoiding this postoperative complication. A majority of anastomoses will appear intact with no obvious sign of anastomotic dehiscence on gross examination. However, each anastomosis should be interrogated before the conclusion of an operation. The most common method to assess for an anastomotic leak is the air leak test (ALT). The ALT is a safe intraoperative method utilized to test the integrity of left-sided colon and rectal anastomoses and most importantly allows the ability to repair a failed test before concluding the operation. Additional troubleshooting is sometimes needed due to technical difficulties with the circular stapler. Problems, such as incomplete doughnuts and stapler misfiring, do occur and each surgeon should be prepared to address them.

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Successful Management of a Positive Air Leak Test during Laparoscopic Colorectal Surgery

Digestive Surgery ◽

10.1159/000480157 ◽

2017 ◽

Vol 35 (3) ◽

pp. 266-270 ◽

Cited By ~ 3

Author(s):

Kazuhito Sasaki ◽

Soichiro Ishihara ◽

Hiroaki Nozawa ◽

Kazushige Kawai ◽

Keisuke Hata ◽

...

Keyword(s):

Colorectal Surgery ◽

Laparoscopic Colorectal Surgery ◽

Air Leak ◽

Leak Test ◽

Successful Management ◽

Air Leak Test

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Intraoperative air leak test reduces the rate of postoperative anastomotic leak: analysis of 777 laparoscopic left-sided colon resections

Surgical Endoscopy ◽

10.1007/s00464-018-6421-8 ◽

2018 ◽

Vol 33 (5) ◽

pp. 1592-1599 ◽

Cited By ~ 13

Author(s):

Marco Ettore Allaix ◽

Adriana Lena ◽

Maurizio Degiuli ◽

Alberto Arezzo ◽

Roberto Passera ◽

...

Keyword(s):

Anastomotic Leak ◽

Air Leak ◽

Leak Test ◽

Air Leak Test ◽

Postoperative Anastomotic Leak

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The endotracheal tube air leak test does not predict extubation outcome in critically ill pediatric patients

Pediatric Critical Care Medicine ◽

10.1097/pcc.0b013e3181849901 ◽

2008 ◽

Vol 9 (5) ◽

pp. 490-496 ◽

Cited By ~ 42

Author(s):

Angela T. Wratney ◽

Daniel Kelly Benjamin ◽

Anthony D. Slonim ◽

James He ◽

Donna S. Hamel ◽

...

Keyword(s):

Endotracheal Tube ◽

Critically Ill ◽

Pediatric Patients ◽

Air Leak ◽

Leak Test ◽

Air Leak Test ◽

Extubation Outcome

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Experimental Study of Mechanical Integrity Testing in Stapled Large Bowel: Methylene Blue Leak Test Is Not Inferior to Air Leak Test

Visceral Medicine ◽

10.1159/000510660 ◽

2020 ◽

pp. 1-9

Author(s):

Marius Kryzauskas ◽

Austeja Elzbieta Degutyte ◽

Vilius Abeciunas ◽

Beatrice Lukenaite ◽

Eugenijus Jasiunas ◽

...

Keyword(s):

Methylene Blue ◽

Colorectal Anastomosis ◽

Linear Stapler ◽

Bursting Pressure ◽

Air Leak ◽

Leak Test ◽

Pressure Monitor ◽

Mechanical Integrity ◽

Air Leak Test ◽

Significant Difference

Background/Objectives: Anastomotic leakage remains the most devastating postoperative complication in colorectal surgery. The mechanical integrity of the newly formed colorectal anastomosis can be evaluated by visual inspection intraoperatively; both air leak and liquid leak tests are also used to evaluate the integrity of stapled colorectal anastomoses. It is not clear whether double-stapled anastomoses are more prone to leaks than single-stapled anastomoses. The aim of our study was to compare the methylene blue and the air leak test in the experimental setting of single-stapled and double-stapled porcine bowels. Methods: Twenty-four distal colons were excised from slaughtered pigs without delay. The proximal bowel end was closed with a linear stapler using blue cartridges. The bowels were randomly divided into single-stapled or double-stapled groups. Air leak and methylene blue leak tests were performed. A digital pressure monitor with a gradual pressure increase function was used to both gradually increase pressure within the bowel and to determine the pressure at which the stapler line disintegrated. Results: Air leakage occurred at a mean pressure of 51.62 (±16.60) mm Hg and methylene blue leakage occurred at 46.54 (±16.78) mm Hg (p = 0.31). The air and methylene blue leaks occurred at comparable pressures in single-stapled bowels and in double-stapled bowels (47.21 [±14.02] mm Hg vs. 50.96 [±19.15] mm Hg, p = 0.6). Conclusions: The methylene blue solution leak test is not inferior to the air leak test. There is no significant difference in bursting pressure between single-stapled and double-stapled anastomoses.

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Air mass spectrometer leak detection using the special air leak test (SALT) cart

Journal of Vacuum Science & Technology A Vacuum Surfaces and Films ◽

10.1116/1.572693 ◽

1984 ◽

Vol 2 (2) ◽

pp. 1157-1161 ◽

Cited By ~ 3

Author(s):

G. M. Solomon

Keyword(s):

Mass Spectrometer ◽

Leak Detection ◽

Air Leak ◽

Leak Test ◽

Air Mass ◽

Air Leak Test

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Novel air leak test and step-by-step strategy for preventing the air leak in lung surgery

Journal of Thoracic Disease ◽

10.21037/jtd.2019.08.68 ◽

2019 ◽

Vol 11 (8) ◽

pp. E106-E108

Author(s):

Hee Chul Yang ◽

Hye Young Chang

Keyword(s):

Lung Surgery ◽

Air Leak ◽

Leak Test ◽

Air Leak Test

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Tubeless uniportal thoracoscopic wedge resection with modified air leak test and chest tube drainage

BMC Surgery ◽

10.1186/s12893-020-00910-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Zhengcheng Liu ◽

Rusong Yang ◽

Yang Sun

Keyword(s):

Chest Tube ◽

Wedge Resection ◽

Pulmonary Nodules ◽

Chest Tube Drainage ◽

Air Leak ◽

Leak Test ◽

Tube Drainage ◽

Incision Size ◽

Air Leak Test ◽

Drainage Group

Abstract Background To investigate whether tubeless uniportal thoracoscopic wedge resection with modified air leak test and chest tube drainage has better short-term outcomes than non-intubated approach with chest tube drainage. Methods Data were collected retrospectively from January 2017 and December 2019. Tubeless group included 55 patients with pulmonary nodules underwent tubeless uniportal thoracoscopic wedge resection, 211 patients underwent non-intubated uniportal thoracoscopic wedge resection with chest tube drainage were included in drainage group. Peri-operative outcomes between two groups were compared. Results After 1:1 matching, 110 patients remained for analysis, baseline demographic and clinical variables were comparable between the two groups. Mean incision size was 3 cm in both group. Mean operative time was 59.3 min in tubeless group and 52.8 min in drainage group. The detectable mean lowest SpO2 and mean peak EtCO2 during operation was acceptable in both groups. Conversion to intubated ventilation or thoracotomy was not required. No patient failed the air leak test and did not undergo a tubeless procedure. Mean postoperative hospital stay was 1.5 days in tubeless group and 2.5 days in drainage group. Residual pneumothorax or subcutaneous emphysema was not frequent and mild in tubeless group. Side effects were rare and mild, including cough and hemoptysis. No re-intervention or readmission occurred. The postoperative VAS score was significantly lower in tubeless group. Conclusions Tubeless uniportal thoracoscopic wedge resection with modified air leak test and chest tube drainage is feasible and safe for selected patients with peripheral pulmonary nodules, it might reduce post-operation pain and lead to faster recovery.

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PREDICTING POST-EXTUBATION STRIDOR IN CHILDREN USING THE ENDOTRACHEAL TUBE AIR LEAK TEST

Critical Care Medicine ◽

10.1097/00003246-199912001-00120 ◽

1999 ◽

Vol 27 (Supplement) ◽

pp. A55

Author(s):

Hee Won Kim ◽

Richard B Mink

Keyword(s):

Endotracheal Tube ◽

Air Leak ◽

Leak Test ◽

Air Leak Test

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DISAIN SISTEM KENDALI MESIN AIR LEAK TEST MENGGUNAKAN SISTEM KENDALI PLC OMRON CJ2M DI HVAC (HEATING, VENTILATING, AND AIR CONDITIONING) LINE 6

SINERGI ◽

10.22441/sinergi.2015.1.002 ◽

2015 ◽

Vol 19 (1) ◽

pp. 7

Author(s):

Syahril Ardi ◽

Setyowati .

Keyword(s):

Air Conditioning ◽

Differential Pressure ◽

Air Leak ◽

Leak Test ◽

Air Leak Test

Pada proses produksi pembuatan komponen HVAC (Heating, Ventilating, and Air Conditioning) dari perusahaan manufaktur di Indonesia, memerlukan proses pengecekan kebocoran pada bagian HVAC. Proses pengecekan ini dilakukan untuk memastikan tidak ada komponen HVAC yang bocor sebelum dikirim ke pihak pelanggan. Penelitian ini dilakukan untuk membuat system dan alat air leak test. Mesin air leak test ini menggunakan prinsip kerja differential pressure air leak test, yaitu metode yang membandingkan antara tekanan udara yang diberikan ke produk dan master produk. Pada penelitian ini, kami membuat disain mesin air leak test menggunakan sistem kendali berupa air leak tester, PLC, dan HMI. Berdasarkan kondisi dengan kapasitas produksi yang meningkat karena bertambahnya permintaan dari customer, dapat ditanggulangi dengan adanya share loading produksi dari HVAC line 4 ke line baru, yaitu HVAC line 6. Hasil yang didapat dari pengujian deteksi kebocoran produk,didapat nilai parameter kebocoran produk sebesar 2.23 ml/min.

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