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 Occult anastomotic leakage after rectal resection in patients with diverting stoma: Exploring optimal indications and examination of early stoma closure

2019 ◽  
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 BackgroundIn the immediate postoperative period, neither have the incidence and risk factors of occult anastomotic leakage (AL) in patients with diverting stoma (DS) been clarified, nor have methods to assess anastomosis been standardized. Before introducing “early stoma closure”, both standardized inclusion and exclusion criteria and standardized methods to assess anastomosis are necessary. 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.MethodsThis was a single institutional prospective observational study of patients who had undergone rectal resection with DS between May and October 2019. All patients had undergone CE and CT to assess for anastomosis 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 7ResultsThe incidence of occult AL on postoperative day 7 was 40%. Hand-sewn anastomosis, compared with stapled anastomosis, was a statistically significant risk factor (p=0.0406). 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.ConclusionsHand-sewn anastomosis was 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 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

Recurrence of rectal anastomotic leakage following stoma closure: assessment of risk factors

2019 ◽  
Vol 21 (11) ◽  
pp. 1304-1311 ◽  
Author(s):  
D. Kitaguchi ◽  
Y. Nishizawa ◽  
T. Sasaki ◽  
Y. Tsukada ◽  
K. Ikeda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Anastomotic Leakage ◽  
Stoma Closure

scholarly journals Defunctioning Protective Stoma Can Reduce the Rate of Anastomotic Leakage After Low Anterior Resection in Rectal Cancer Patients

2020 ◽  
Vol 36 (3) ◽  
pp. 192-197 ◽  
Author(s):  
Byoung Chul Lee ◽  
Seok-Byung Lim ◽  
Jong Lyul Lee ◽  
Chan Wook Kim ◽  
Yong Sik Yoon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Anastomotic Leakage ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Clinicopathological Parameters ◽  
Emergency Laparotomy ◽  
Stoma Formation ◽  
Diverting Stoma ◽  
The Impact ◽  
Protective Stoma

Purpose: This study aimed to identify risk factors for anastomotic leakage and to evaluate the impact of protective stoma on the rate of anastomotic leakage and subsequent management.Methods: This retrospective study analyzed data from 4,282 patients who underwent low anterior resection between 2007 and 2014. Among these, 1,367 (31.9%) underwent surgery to create protective diverting stoma and 232 (5.4%) experienced anastomotic leakage. At 6-month timepoints, data were evaluated to identify any correlation between the presence of diverting stoma and the incidence of anastomotic leakage. In addition, clinicopathological parameters were investigated to identify risk factors for anastomotic leakage.Results: Diverting stomas significantly reduced the rate of anastomotic leakage (hazard ratio, 0.334; 95% confidence interval, 0.212–0.525; P<0.001], which was reciprocally correlated with the rate of diverting stoma formation (P=0.039). Patients with a diverting stoma had a significantly lower incidence of generalized peritonitis (P<0.001) and therefore significantly reduced need for laparotomy (82.7% vs. 39.1%, P<0.001).Conclusion: The selective use of diverting stoma in high-risk patients decreases the rate of anastomotic leakage. Diverting stoma also affects the type of leakage and reduces the need for emergency laparotomy by approximately 40%.

62 THE STERNO-TRACHEAL DISTANCE IS AN IMPORTANT FACTOR OF ANASTOMOTIC LEAKAGE OF RETROSTERNAL GASTRIC TUBE RECONSTRUCTION AFTER ESOPHAGECTOMY

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
S Inoue
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Anastomotic Leakage ◽  
Gastric Tube ◽  
Independent Risk Factor ◽  
Cutoff Value ◽  
Subtotal Esophagectomy ◽  
Posterior Mediastinal ◽  
Route Reconstruction ◽  
Gastric Tube Reconstruction

Abstract Background Anastomotic leakage (AL) is a serious complication after esophagectomy. The retrosternal (RS) route has been selected majorly to reduce reflux and related pneumonia and considering mediastinal recurrences. AL has been developed more in RS than posterior mediastinal (PM) route reconstruction. Therefore, we suspected the sterno-tracheal distance (STD) might be related to AL and started the selection according to the STD from 2009. Methods A total of 221 patients who underwent a subtotal esophagectomy with gastric tube reconstruction during January 2004—April 2017 were investigated. The patients were classified into the 'after STD selection' (A; n = 144) group and the 'before STD selection' (B, n = 77) group. The incidences of and the risk factors for AL between the two groups were compared. Results The incidence of AL was high in the B group (18.2%), and 78.6% of the patients who developed AL were treated with RS route. The median STDs of the patients with AL and no AL were 10.3 mm and 14.5 mm, respectively (p = 0.001). These results demonstrated that the STD was a risk factor for AL in the RS route. Based on these results, 13 mm was set as the cutoff value. After STD selection, the median STD increased from 14.0 mm to 17.3 mm (p = 0.001), and the incidence of AL decreased significantly from 26.2% to 11.1% in the RS route (p = 0.037). Conclusion The STD was the independent risk factor for AL in the RS route. RS route reconstruction should be avoided for the patients with STD &lt;13 mm.

scholarly journals A Retrospective Study of Risk Factors for Symptomatic Anastomotic Leakage after Laparoscopic Anterior Resection of the Rectal Cancer without a Diverting Stoma

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Zhi-Jie Wang ◽  
Qian Liu
Keyword(s):  
Risk Factors ◽  
Anastomotic Leakage ◽  
Anterior Resection ◽  
Univariate Analysis ◽  
Control Group ◽  
Primary Malignancy ◽  
Laparoscopic Anterior Resection ◽  
Diverting Stoma ◽  
Independent Risk Factors ◽  
Intraoperative Chemotherapy

Background. Anastomotic leakage (AL) is a common and devastating postoperative issue for patients who have undergone anterior resection of rectal carcinoma and can lead to increased short-term morbidity and mortality. Moreover, it might be associated with a worse oncological prognosis of tumors. This study is aimed at exploring the risk factors for symptomatic AL after laparoscopic anterior resection (LAR) for rectal tumors without a preventive diverting stoma. Materials and Methods. This case control study retrospectively reviewed the data of 496 consecutive patients who underwent LAR of the rectum without a preventive diverting stoma at the Cancer Hospital, Chinese Academy of Medical Sciences between September 2016 and September 2017. All patients were divided into an AL group and a control group based on the occurrence of postoperative symptomatic AL. Factors regarding patient-related variables, operation-related variables, and tumor-related variables were collected and assessed between the two groups through univariate and multivariate logistic regression analyses to identify independent risk factors for AL. Results. In total, 18 (3.6%) patients developed postoperative symptomatic AL. Univariate analysis showed that a synchronous primary malignancy of the left hemicolon (P=0.047), intraoperative chemotherapy (P=0.003), and level of anastomosis (P=0.033) were significantly related with AL. Multivariate analysis was subsequently performed to adjust for confounding biases and confirmed that a synchronous primary malignancy of the left hemicolon (odds ratio (OR), 12.225; 95% confidence interval (CI), 1.764-84.702; P=0.011), intraoperative chemotherapy (OR, 3.931; 95% CI, 1.334-11.583; P=0.013), and level of anastomosis (OR, 3.224; 95% CI, 1.124-9.249; P=0.030) were independent risk factors for symptomatic AL for patients who received LAR for rectal neoplasms without a preventive diverting stoma. Conclusions. Synchronous primary malignancy of the left hemicolon, intraoperative chemotherapy, and a low anastomotic level can increase the risks of postoperative symptomatic AL after LAR of the rectum without a protective diverting stoma.

scholarly journals Strategy to Avoid Anastomotic Leakage in Laparoscopic Colorectal Resection Using the Indocyanine Green Fluorescence System

2021 ◽  
Vol 105 (1-3) ◽  
pp. 714-719
Author(s):  
Jun Higashijima ◽  
Toshiaki Yoshimoto ◽  
Shohei Eto ◽  
Hideya Kashihara ◽  
Chie Takasu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Flow ◽  
Indocyanine Green ◽  
Anastomotic Leakage ◽  
Colorectal Resection ◽  
Green Fluorescence ◽  
Laparoscopic Colorectal Resection ◽  
Indocyanine Green Fluorescence ◽  
Diverting Stoma ◽  
Double Stapling

Purpose Anastomotic leakage (AL) in colorectal resections is often caused by insufficient blood flow to the stump. Injecting indocyanine green can help detect blood flow intraoperatively. In this study, we evaluated our original strategy using an indocyanine green fluorescence system to avoid AL. Methods We retrospectively evaluated 79 patients who underwent laparoscopic colorectal resection for colon cancer using a double-stapling technique. Blood flow in oral stumps was evaluated by measuring indocyanine green fluorescence time (FT). We investigated AL cases in detail and analyzed correlations between FT and risk factors for AL. Results Of the 79 patients, 7 (8.9%) developed AL. We divided patients by FTs: &gt;60 seconds, 50 to 60 seconds, and &lt;50 seconds. The AL rates were FT &gt;60 seconds, 60%; FT 50 to 60 seconds, 10.3%; and FT &lt;50 seconds, 2.2%. The AL rate of high-risk cases (with more than 2 risk factors) were calculated and we made our original strategy to avoid AL as the following. Further resection or diverting stomas were needed by the FT &gt;60 seconds group, and by members of the FT 50 to 60 seconds group with ≥3 risk factors. The FT &lt;60 seconds group needed no additional management. Conclusions Patients with delayed FT (&gt;60 seconds, or 50–60 seconds with ≥3 risk factors) may need revision of the anastomosis (diverting stoma or additional resection) to avoid AL. Our original strategy may contribute to reduce AL in colorectal operations.

670 THE STERNO-TRACHEAL DISTANCE IS AN IMPORTANT FACTOR OF ANASTOMOTIC LEAKAGE OF RETROSTERNAL GASTRIC TUBE RECONSTRUCTION AFTER ESOPHAGECTOMY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Seiya Inoue
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Anastomotic Leakage ◽  
Gastric Tube ◽  
Independent Risk Factor ◽  
Cutoff Value ◽  
Posterior Mediastinal ◽  
Total Esophagectomy ◽  
Route Reconstruction ◽  
Gastric Tube Reconstruction

Abstract   Anastomotic leakage (AL) is a serious complication after esophagectomy. The retrosternal (RS) route has been selected majorly to reduce reflux and related pneumonia and considering mediastinal recurrences. AL has been developed more in RS than posterior mediastinal (PM) route reconstruction. Therefore, we suspected the sterno-tracheal distance (STD) might be related to AL and started the selection according to the STD from 2009. Methods A total of 221 patients who underwent a sub total esophagectomy with gastric tube reconstruction during January 2004—April 2017 were investigated. The patients were classified into the 'after STD selection' (A; n = 144) group and the 'before STD selection' (B, n = 77) group. The incidences of and the risk factors for AL between the two groups were compared. Results The incidence of AL was high in the B group (18.2%), and 78.6% of the patients who developed AL were treated with RS route reconstruction. The median STDs of the patients with AL and no AL were 10.3 mm and 14.5 mm, respectively (p = 0.001). These results demonstrated that the STD was a risk factor for AL in RS route. Based on these results, 13 mm was set as the cutoff value. After STD selection, the median STD increased from 14.0 mm to 17.3 mm (p = 0.001), and the incidence of AL decreased significantly from 26.2% to 11.1% in RS route (p = 0.037). Conclusion The STD was the independent risk factor for AL in the RS route. RS route reconstruction should be avoided for the patients with STD &lt;13 mm.

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