Drain fluid amylase as a biomarker for the detection of anastomotic leakage after rectal resection without a diverting ileostomy

2022 ◽  
Author(s):  
David A. Clark ◽  
Aleksandra Edmundson ◽  
Daniel Steffens ◽  
Craig Harris ◽  
Andrew Stevenson ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Rectal Resection ◽  
Diverting Ileostomy ◽  
Drain Fluid

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.

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

scholarly journals Amylase level in cervical drain fluid and anastomotic leakage after cervical oesophagogastrostomy†

2019 ◽  
Vol 56 (2) ◽  
pp. 301-306 ◽  
Author(s):  
Woo Sik Yu ◽  
Joonho Jung ◽  
Hyejung Shin ◽  
Yunho Roh ◽  
Go Eun Byun ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Oral Feeding ◽  
Drainage Tube ◽  
Amylase Level ◽  
Anastomotic Site ◽  
Mixed Model Analysis ◽  
Protein Levels ◽  
Drain Fluid

Abstract OBJECTIVES Anastomotic leakage after oesophageal cancer surgery is a serious complication. The purpose of this study was to evaluate the possibility of anastomotic leakage by repeatedly measuring amylase levels in the fluid obtained from the drainage tube inserted at the cervical anastomotic site. METHODS Ninety-nine patients who underwent oesophagectomy and cervical oesophagogastrostomy between April 2014 and March 2017 were retrospectively reviewed. A drainage tube was placed at the anastomotic site, and amylase levels were measured daily from postoperative day (POD) 1 until oral feeding or confirmation of anastomotic leakage. The amylase levels were analysed with a linear mixed model. RESULTS The mean age of the patients was 64.9 ± 9.0 years, and there were 89 (89%) male patients. Almost all pathologies (92%) were squamous cell carcinomas. The anastomotic methods were as follows: 63 (63%) circular stapled, 33 (33%) hand-sewn and 3 (3%) semistapled. Anastomotic leakage was confirmed in 10 (10%) patients. The amylase levels increased until POD 2 in both the leakage and non-leakage groups, but the levels subsequently decreased in the non-leakage group, whereas the levels peaked on POD 3 in the leakage group. On performing the linear mixed model analysis, anastomotic leakage was significantly associated with the trends in postoperative amylase levels in the drainage tube (P < 0.001). Trends in the serum C-reactive protein levels and white blood cell count were not significantly associated with anastomotic leakage. CONCLUSIONS Amylase level trends measured in the cervical drain fluid can be a useful indicator of anastomotic leakage after cervical oesophagogastrostomy.

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 Role of biomarkers in predicting anastomotic leakage following colorectal surgeries

2020 ◽  
Vol 8 (7) ◽  
pp. 2562
Author(s):  
Mumtaz Din Wani ◽  
Ferkhand Mohi Ud Din ◽  
Aabid Rasool Bhat ◽  
Irshad Ahmad Kumar ◽  
Ashiq Hussain Raina ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Anastomotic Leakage ◽  
Anastomotic Leak ◽  
Sensitivity And Specificity ◽  
Peritoneal Fluid ◽  
Clinical Symptoms ◽  
Colorectal Disease ◽  
Total Leukocyte Count ◽  
Drain Fluid ◽  
The Mean

Background: Recovery after surgery for patients with colorectal disease has improved with the advent of minimal access surgery and standardized recovery protocols. Despite these advances, anastomotic leakage remains one of the most dreaded complications following colorectal surgery, with rates of 3-27 per cent depending on specific risk factors. The aim of the study was to assess sensitivity and specificity of systemic and peritoneal drain-fluid bio-markers in early prediction of anastomotic leak; and to co-relate rise in levels of biomarkers and severity of clinical symptoms in patients who have undergone colo-rectal surgeries.Methods: The present study was a prospective observational study conducted on 60 patients in the Postgraduate Department of Surgery, Government Medical College, Srinagar after obtaining due ethical clearance over a period of two years.Results: The mean age was 54.87±11.901 years with 44 patients (73.3%) were males. Among systemic makers: the mean CRP level was 2.7800±0.500 mg/L, the mean total leukocyte count was 10.783±0.940 thousands and the mean serum procalcitonin level was 0.365±0.1385 ng/ml. Among peritoneal fluid drain bio-makers, the mean IL-6 level was 3551.066±1311.965 pg/ml, the mean IL-10 level was 628.533±460.358 pg/ml and the mean TNF-a level was 16.391±6.736 pg/ml. The anastomotic leak after colo-rectal surgery was noted in 16 patients (26.7%). In our study significant co-relation was noted between the rise in levels of peritoneal drain fluid biomarkers and severity of clinical symptoms but no significant co-relation was noted between the rise in levels of systemic markers and severity of clinical symptoms in patients who have undergone colo-rectal surgeries.Conclusions: Systemic biomarkers are poor predictors of anastomotic leak after colorectal surgery. But sensitivity and specificity of peritoneal fluid drain biomarkers in predicting anastomotic leak was significantly high.

scholarly journals Omentoplasty in the Prevention of Anastomotic Leakage After Colonic or Rectal Resection

1998 ◽  
Vol 227 (2) ◽  
pp. 179-186 ◽  
Author(s):  
Fethi Merad ◽  
Jean-Marie Hay ◽  
Abe Fingerhut ◽  
Yves Flamant ◽  
Jean-Michel Molkhou ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Rectal Resection
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