Longer Operative Time and Intraoperative Blood Transfusion are Associated with Postoperative Anastomotic Leak after Lower Gastrointestinal Surgery

2019 ◽  
Vol 85 (2) ◽  
pp. 136-141
Author(s):  
Chandler S. Cortina ◽  
Gillian C. Alex ◽  
Kristin N. Vercillo ◽  
Vidyaratna A. Fleetwood ◽  
Jill B. Smolevitz ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Anastomotic Leak ◽  
Operative Time ◽  
Intestinal Anastomosis ◽  
Gastrointestinal Surgery ◽  
Operation Time ◽  
Leak Rate ◽  
High Morbidity ◽  
Blood Transfusions ◽  
Postoperative Anastomotic Leak

Anastomotic leak after lower gastrointestinal surgery is a complication with potential for high morbidity, mortality, and increased costs. A single-institution retrospective chart review was performed on all patients who underwent lower gastrointestinal surgery between June 2009 and June 2013. Fifty-seven variables were included in our analysis and their association with postoperative anastomotic leak was examined. Nine hundred fifty-two patients underwent 983 lower gastrointestinal anastomoses with an overall leak rate in this series of 6 per cent. Type of intestinal anastomosis created (P < 0.00005), operative indication (P < 0.015), operation performed (P < 0.014), intraoperative blood transfusion (P < 0.017), and intraoperative surgical drain placement (P < 0.022) were all predictive of anastomotic leak. Anastomotic leak rate increased by 1.3 times for every additional hour in the operating room after three hours. Both increasing operation time and intraoperative blood transfusions were associated with an increased rate of anastomotic leak. When operative time extends beyond three hours or in those cases were blood transfusions are given, surgeons should consider taking steps to minimize the risks of a potential anastomotic leak.

Volume-outcome Relationship in Rectal Cancer Surgery

2021 ◽  
Author(s):  
Leandro Siragusa ◽  
Bruno Sensi ◽  
Danilo Vinci ◽  
Marzia Franceschilli ◽  
Giulia Bagaglini ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Blood Transfusion ◽  
Hospital Stay ◽  
Anastomotic Leak ◽  
Operative Time ◽  
Cancer Surgery ◽  
Leak Rate ◽  
Perioperative Outcomes ◽  
Rectal Cancer Surgery ◽  
Anastomotic Leak Rate

Abstract Introduction Hospital centralization effect is reported to lower complications and mortality for high risk and complex surgery operations, including colorectal surgery. However, no linear relation between volume and outcome has been demonstrated. Aim of the study was to evaluate the increased surgical volume effect on early outcomes of patient undergoing laparoscopic restorative anterior rectal resection (ARR).Methods A retrospective analysis of all consecutive patients undergoing ARR with primary anastomosis between November 2016 and December 2020 after centralization of rectal cancer cases in an academic Centre. Short outcomes are compared to those of patients operated in the same unit during the previous 10 years before service centralization. The primary outcome was anastomotic leak rate. Mean operative time, need of conversion, postoperative use of blood transfusion, radicality, in-hospital stay, number and type of complications, readmission and reoperation rate, mortality and 1-year and stoma persistence rates were evaluated as secondary outcomes.Results 86 patients were operated in the study period and outcomes compared to those of 101 patients operated during the previous ten years. Difference in volume of surgery was significant between the two periods (p 0.019) and the estimated leak rate was significantly lower in the higher volume unit (p 0.05). Mean operative time, need of conversion, postoperative use of blood transfusion and in-hospital stay (p <0.05) were also significantly reduced in Group A.Conclusion: This study suggests that the shift toward higher volume in rectal cancer surgery is associated to decreased anastomotic leak rate. Potentiation of lower volume surgical units may yield optimal perioperative outcomes.

scholarly journals Volume-outcome relationship in rectal cancer surgery

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
L. Siragusa ◽  
B. Sensi ◽  
D. Vinci ◽  
M. Franceschilli ◽  
C. Pathirannehalage Don ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Blood Transfusion ◽  
Hospital Stay ◽  
Anastomotic Leak ◽  
Operative Time ◽  
Cancer Surgery ◽  
Leak Rate ◽  
Perioperative Outcomes ◽  
Rectal Cancer Surgery ◽  
Anastomotic Leak Rate

Abstract Introduction Hospital centralization effect is reported to lower complications and mortality for high risk and complex surgery operations, including colorectal surgery. However, no linear relation between volume and outcome has been demonstrated. Aim of the study was to evaluate the increased surgical volume effect on early outcomes of patient undergoing laparoscopic restorative anterior rectal resection (ARR). Methods A retrospective analysis of all consecutive patients undergoing ARR with primary anastomosis between November 2016 and December 2020 after centralization of rectal cancer cases in an academic Centre. Short-term outcomes are compared to those of patients operated in the same unit during the previous 10 years before service centralization. The primary outcome was estimated anastomotic leak rate. Mean operative time, need of conversion, postoperative use of blood transfusion, radicality, in-hospital stay, number and type of complications, readmission and reoperation rate, mortality and 1-year and stoma persistence rates were evaluated as secondary outcomes. Results 86 patients were operated in the study period and outcomes compared to those of 101 patients operated during the previous ten years. Difference in volume of surgery was significant between the two periods (p 0.019) and the estimated leak rate was significantly lower in the higher volume unit (p 0.047). Mean operative time, need of conversion, postoperative use of blood transfusion and in-hospital stay (p < 0.05) were also significantly reduced in Group A. Conclusion This study suggests that the shift toward higher volume in rectal cancer surgery is associated to decreased anastomotic leak rate. Potentiation of lower volume surgical units may yield optimal perioperative outcomes.

scholarly journals A prospective study of 50 cases of laparoscopic intestinal anastomosis by Endo GIA universal loading stapler (green/blue) versus Endo GIA articulating reload with tri staple technology (purple)

2020 ◽  
Vol 7 (11) ◽  
pp. 3657
Author(s):  
Mehulkumar K. Vasaiya ◽  
Samir M. Shah ◽  
Vikram B. Gohil ◽  
Milankumar S. Vaghasia
Keyword(s):  
Anastomotic Leak ◽  
Staple Line ◽  
Intestinal Anastomosis ◽  
Operation Time ◽  
Clinical Safety ◽  
Postoperative Anastomotic Leak ◽  
Group A ◽  
Prospective Comparative Study ◽  
Group B ◽  
A Prospective Study

Background: Intestinal anastomosis is a commonly performed procedure in surgery. Various evolvements have occurred in the field of intestinal anastomosis and recent advancement is the use of stapler in laparoscopic surgeries as a device for Gastrointestinal (GI) anastomosis. Few previous studies evaluating the clinical safety of the 2 laparoscopic linear stapling devices are available.Methods: A prospective comparative study of 50 cases which met the inclusion and exclusion criteria were included in this hospital-based study. They were randomly allocated to two groups, Group A which underwent laparoscopic intestinal anastomosis by Endo GIA tri-staple (purple) stapler and Group B which underwent Endo GIA universal loading unit (blue/green) stapler. Primary outcome was assessed in terms of intra-operative staple line bleeding, operative time and post-operative anastomotic leak.Results: Patients with laparoscopic intestinal anastomosis by Endo GIA tri-staple stapler (purple) have required less operation time as compared to Endo GIA universal loading unit. In Endo GIA universal loading unit (blue/green) 04% patients developed anastomotic leak and 40% patients had intra-operative staple line bleed while with Endo GIA tri-staple no postoperative anastomotic leak was found and 02% patients developed intra-operative staple line bleeding.Conclusions: The result of our study has shown that the Endo GIA reload tri- staple (purple) is superior in terms of having no anastomosis leak, negligent staple line bleeding and less operation time as compared with Endo GIA universal loading unit (blue/green). Thus, laparoscopic intestinal anastomosis by Endo GIA reload tri-staple stapler (purple) technology is more effective and overall more efficient.

scholarly journals Frequency and Outcomes of Anastomotic Leak in Gastrointestinal Surgery at Public Sector Hospital

2017 ◽  
Vol 23 (2) ◽  
Author(s):  
Gulshan Ali Memon ◽  
Habib Ur Rehman ◽  
Syed Kashif Ali Shah ◽  
Rafiq Ahmed Sahito ◽  
Shahnawaz Leghari ◽  
...  
Keyword(s):  
Anastomotic Leak ◽  
Intestinal Anastomosis ◽  
National Level ◽  
Gastrointestinal Surgery ◽  
Length Of Hospital Stay ◽  
Large Data ◽  
Cross Sectional Study ◽  
Secondary Outcome ◽  
Cross Sectional ◽  
Resection And Anastomosis

AbstractObjective:  The objective of this study was to find out frequency of anastomotic leak at a hospital and deplore the morbidities, duration of hospital stay.Methods:  A total of 102 patients of both genders from 18 – 60 years in age underwent for bowel resection and anastomosis through laparotomy incision at surgical unit one of People’s University of Medical & Health Sciences, Nawabshah, from January 2013 to December 2016 were enrolled in this cross-sectional study. Every patient received appropriate antibiotics for duration according to need post-operatively. Follow-up was every fortnightly for four months to evaluate the primary outcome as prevalence of leak and secondary outcome as morbidities, length of hospital stay incisional hernia and mortality.Results:  The results showed that, out of 102 patients underwent open primary hand sewn gastro intestinal anastomosis, 16 (15.68%) were found with anastomotic leak. Among these 16 patients having anatomic leak, 11 (11%) were male & 5 (5%) were female. While, mortality occurred in 05 (5%%) patients.Conclusions:  Anastomotic leak following gastrointestinal anastomosis is less complication in this study. Further studies are requested with large data and more follow-ups to ensure the findings of this study at national level.

scholarly journals Predictors of perioperative blood transfusion and intraoperative blood loss in thoracolumbar tuberculosis

2020 ◽  
Author(s):  
Shengyu Wang ◽  
Chao Liu ◽  
Rongzhi Wei ◽  
Qiuhua Zhang ◽  
Feng Wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Operative Time ◽  
Blood Transfusions ◽  
Intraoperative Blood Loss ◽  
Multivariate Logistic Regression ◽  
Perioperative Blood Transfusion

Abstract Background. During surgery for thoracic and lumbar tuberculosis infection, patients can lose a significant amount of blood and thus require a perioperative blood transfusion. However, the risk factors for increased intraoperative blood loss and perioperative blood transfusion have yet to be identified. The aim of this retrospective study was to determine the predictors of perioperative blood transfusion and intraoperative blood loss in thoracolumbar tuberculosis. Methods. From 2008 to 2018, 336 patients who met the inclusion criteria were enrolled in the study. The predictors of allogenic blood transfusion were identified using univariate and multivariate logistic regression analyses. Univariate and multivariate linear regressions were conducted to investigate the risk factors for intraoperative blood loss. The predictors of high levels of intraoperative blood loss were analyzed by multivariate logistic regression analysis.Results. Altogether, 336 adult patients with thoracic and lumbar tuberculosis were included in this study. The mean age of patients was 49.6 ± 15.5 years old (range 14-85). Our data revealed significant relationships between blood transfusions and female gender, BMI, vertebral collapse/kyphosis and intraoperative blood loss. Multivariable linear regression analysis revealed that BMI, levels of instrumentation, surgical approach and operative time were independent risk factors for intraoperative blood loss. Specifically, a lower BMI, decreased preoperative hemoglobin levels, four or more levels of instrumentation, a combined surgical approach and a prolonged operative time were identified as risk factors for high levels of intraoperative blood loss.Conclusions. This study identified some clinical predictors of perioperative blood transfusion and intraoperative blood loss in patients undergoing thoracic and lumbar tuberculosis surgery. These results may contribute to the planning of preoperative blood transfusions and help to minimize intra- or postoperative complications. Level of evidenceLevel IV, retrospective case series.

scholarly journals Factors influencing intestinal anastomotic leak and their predictive value

2019 ◽  
Vol 6 (12) ◽  
pp. 4495
Author(s):  
Abhishek Jina ◽  
Umesh Chandra Singh
Keyword(s):  
Risk Factors ◽  
Socioeconomic Status ◽  
Anastomotic Leak ◽  
Low Socioeconomic Status ◽  
Odds Ratio ◽  
Intestinal Anastomosis ◽  
Significant Risk ◽  
Leak Rate ◽  
Duration Of Surgery ◽  
Potential Risk Factors

Background: Anastomotic leak after intestinal surgery is one of the major reasons behind postoperative morbidity and mortality. This prospective study was undertaken to evaluate various risk factors for anastomotic leakage.Methods: This study was conducted in B.R.D. Medical College, Gorakhpur, Department of surgery from May 2015 to October 2016. Patients who underwent intestinal anastomosis in emergency settings or routine operation were included in this study. Total of 156 patients were included.Results: Anastomotic leak was observed in 16.02% cases and was higher in males and in patients from low socioeconomic status. However, age, sex, and socioeconomic status were not found to be significant risk factors for anastomotic leak. Leak rate was higher in patients suffering from chronic diseases such as malignancy; COPD, DM, and patients with chronic corticosteroid use. Leak rate was significantly high in malnourished patients and in cases having sepsis as shown by their blood investigation report. After logistic regression analysis it was observe that various independent predictors for anastomotic leakages are peritonitis (p<0.05; odds ratio 2.166), bowel obstructions (p<0.05; odds ratio 2.844), blood transfusion>2 u (p<0.05; odds ratio 2.354), S. Albumin <3.0 gm/di (p<0.001; odds ratio 8.873), corticosteroid therapy (p<0.001; odds ratio 4.857), serum creatinine >1.2 mg/dl (p<0.001; odds ratio 11.755), duration of surgery (>4 hrs) (p<0.01; odds ratio 3.0251) and ASA Grading (III&IV) (p<0.01; odds ratio 3.607).Conclusions: This study has identified the potential risk factors that affect the incidence of anastomotic leakage and the result of this study will be helpful in reducing the incidence of AL after surgeries. 

scholarly journals A Comparative Study of Single Layer Versus Double layer Intestinal Anastomosis

2018 ◽  
Vol 1 (2) ◽  
pp. 98-101 ◽  
Author(s):  
Amar Gurung ◽  
Santosh Shrestha ◽  
Devendra Shrestha ◽  
Suresh Raj Paudel ◽  
David Shrestha ◽  
...  
Keyword(s):  
Comparative Study ◽  
Anastomotic Leak ◽  
Double Layer ◽  
Intestinal Anastomosis ◽  
Single Layer ◽  
Regional Hospital ◽  
Layer Versus ◽  
Layer Technique ◽  
Postoperative Anastomotic Leak ◽  
Western Regional

Objective: To determine the efficacy of single layer intestinal anastomosis to double layer technique in terms of anastomotic healing. Materials and Methods: Fifty patients who underwent intestinal anastomosis in the Department of Surgery, Western Regional Hospital from June 2014 to May 2016 were taken for this comparative study and divided equally in two groups, 25 each (single layer and double layer). Results: Of the total fifty cases, twenty-five cases included in each group, there was no leakage in single layer group while 1 patient had leakage in double layer group which was statistically insignificant. Conclusion: Single layer interrupted intestinal anastomosis is simple to carry out and is as efficacious as double layer anastomosis in terms of postoperative anastomotic leak.

scholarly journals Factors affecting the outcome of intestinal anastomosis: a prospective study

2021 ◽  
Vol 8 (5) ◽  
pp. 1433
Author(s):  
Vishnu Shanker ◽  
Roop Kishan Kaul ◽  
Abhishek Singh Rathore
Keyword(s):  
Risk Factors ◽  
Prospective Study ◽  
Anastomotic Leak ◽  
Operative Time ◽  
Intestinal Anastomosis ◽  
Anastomotic Dehiscence ◽  
Research Centre ◽  
Anastomotic Leaks ◽  
Factors Associated ◽  
A Prospective Study

Background: Anastomotic leak is one of the most dreaded complications after intestinal anastomosis. The prevalence of anastomotic leak is 0.5%-30% in literature and resulting mortality rate is 10%-15%. Various risk factors are known to be associated with it. This study was undertaken with the aim to identify and evaluate these predisposing factors.Methods: A prospective study was conducted from March 2019 to February 2020 at Teerthankar Mahaveer medical college and research centre, Moradabad. All patients undergoing hand-sewn gastro-intestinal anastomosis electively as well as in emergency were included in this study. The total number of cases studied were 80.Results: Post-operative anastomotic leaks were present in 10% and associated mortality was 100%. Increasing age was associated with leakage (p=0.02) and 75% patients with leaks were male. The following were observed to be significant risk factors associated with anastomotic dehiscence: diabetes mellitus (p=0.05), pallor (p=0.01), low haemoglobin (p=0.003), altered TLC count (p=0.008) low serum protein (p=0.001), albumin (p=0.001) longer operative time (p=0.02). Other predisposing factors like serum creatinine, hyperbilirubinema, elective/emergency surgeries, contamination of peritoneal cavity and time taken to perform the anastomosis were insignificant statistically.Conclusions: This study identified and assessed the various risk factors associated with anastomotic leaks and found age, sex, anaemia, sepsis, hypoproteinemia, hypoalbuminemia, increased operative-time to be significant and we concluded that controlling these factors will help in minimizing the chances of anastomotic dehiscence.

Use of indocianine green fluorescence in acute mesenteric ischemia

2020 ◽  
Vol 3 (2) ◽  
Author(s):  
Jaime Bonnín-Pascual
Keyword(s):  
Indocyanine Green ◽  
Terminal Ileum ◽  
Mesenteric Ischemia ◽  
Intestinal Anastomosis ◽  
Acute Mesenteric Ischemia ◽  
Left Colon ◽  
Infrared Light ◽  
High Morbidity ◽  
Green Fluorescence ◽  
Clinical Cases

Introduction: Acute mesenteric ischemia has a high morbidity and mortality and constitutes an intraoperative challenge in the management of ischemic areas. In this context, we analyze the use of indocyanine green fluorescence to assess intestinal vascularization through 3 clinical cases. Case presentation: we present 3 clinical cases operated for acute mesenteric ischemia. Evaluation of intestinal viability is performed under infrared light after intravenous infusion of 25 mg of indocyanine green. Case 1 is a 42-year-old male with multiple antecedents of severe vascular disease, presenting with a massive acute mesenteric ischemia involving multiple intestinal segments. Fluorescence allows two adjusted bowel resections with double intestinal anastomosis. Case 2 is a 74-year-old woman with a history of non-anticoagulated atrial fibrillation who is decided to perform an urgent surgery when an esophageal, gastric and portal system pneumatosis is observed, as indirect signs of ischemia, in urgent CT. During the surgical act there is an ischemia of the terminal ileum and right colon without clear signs of involvement at the esophageal-gastric level. The assessment after administration of ICG discriminates the clear ischemic involvement from terminal ileum to ascending colon and patched in the transverse and left colon, without esophageal or gastric involvement. Case 3 is a 49-year-old woman with aortoiliac and visceral Takayasu disease and revascularization surgery of the celiac trunk. Given the increase in abdominal pain, a new CT scan demonstrates colonic pneumatosis. Urgent laparotomy shows necrosis at the level of the left colon and hypoperfusion of the cecum. The administration of ICG finds a lack of uptake of the entire colon. A subtotal colectomy with ileostomy and mucous fistula is performed. Introduction: Acute mesenteric ischemia has a high morbidity and mortality and constitutes an intraoperative challenge in the management of ischemic areas. In this context, we analyze the use of indocyanine green fluorescence to assess intestinal vascularization through 3 clinical cases. Case presentation: we present 3 clinical cases operated for acute mesenteric ischemia. Evaluation of intestinal viability is performed under infrared light after intravenous infusion of 25 mg of indocyanine green. Case 1 is a 42-year-old male with multiple antecedents of severe vascular disease, presenting with a massive acute mesenteric ischemia involving multiple intestinal segments. Fluorescence allows two adjusted bowel resections with double intestinal anastomosis. Case 2 is a 74-year-old woman with a history of non-anticoagulated atrial fibrillation who is decided to perform an urgent surgery when an esophageal, gastric and portal system pneumatosis is observed, as indirect signs of ischemia, in urgent CT. During the surgical act there is an ischemia of the terminal ileum and right colon without clear signs of involvement at the esophageal-gastric level. The assessment after administration of ICG discriminates the clear ischemic involvement from terminal ileum to ascending colon and patched in the transverse and left colon, without esophageal or gastric involvement. Case 3 is a 49-year-old woman with aortoiliac and visceral Takayasu disease and revascularization surgery of the celiac trunk. Given the increase in abdominal pain, a new CT scan demonstrates colonic pneumatosis. Urgent laparotomy shows necrosis at the level of the left colon and hypoperfusion of the cecum. The administration of ICG finds a lack of uptake of the entire colon. A subtotal colectomy with ileostomy and mucous fistula is performed. Conclusions: The fluorescence with ICG provides a better visualization of the intestinal vascularization in the AMI, and allows to determine the limits of the affected tissue to perform adjusted resections.

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