175 Detection of Anastomotic Leaks After Colorectal Surgery by Measuring LPS in the Drainage Fluid

Junqer, W.; Miller, Karl; Bahrami, Soheyl; Redl, Heinz; Schlaq, G.; Moritz, E.

doi:10.1097/00024382-199505000-00176

Cited by 14 publications

(20 citation statements)

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“…There is evidence of local ischaemia 24 h after surgery in patients who subsequently develop AL , while rises in lactate and lactate/pyruvate levels precede clinical detection of AL by several days . Similarly, systemic and peritoneal inflammatory mediators rise significantly by POD 2 (in some cases, within hours) in patients who subsequently develop AL . Thus, our findings suggesting that AL is an early event are supported by biochemical evidence in the extant literature.…”

Section: Discussionsupporting

confidence: 82%

Physiological changes after colorectal surgery suggest that anastomotic leakage is an early event: a retrospective cohort study

et al. 2019

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Aim Anastomotic leakage (AL) is often identified 7–10 days after colorectal surgery. However, in retrospect, abnormalities may be evident much earlier. This study aims to identify the clinical time point when AL occurs. Method This is a retrospective case‐matched cohort comparison study, assessing patients undergoing left‐sided colorectal resection between 2006 and 2015 at a specialist colorectal unit. Patients who developed AL (LEAK) were case‐matched to two CONTROL patients by procedure, gender, laparoscopic modality and diverting stoma. Case note review allowed the collection of basic observation data and blood tests (leukocyte count, C‐reactive protein, bilirubin, alanine transaminase, creatinine) up to postoperative day (POD) 4. The cohorts were compared, with the main outcome measure being changes in basic observation data. Results Of 554 patients, 49 developed AL. These were matched to 98 CONTROL patients. Notes were available for 105 patients (32 LEAK/73 CONTROL). Groups were similar in demographics, tumour or nodal status, preoperative radiotherapy, intra‐operative air‐leak integrity and drain usage. AL was detected clinically at a median of 7.5 days postoperatively. There was a significantly increased heart rate by the evening on POD 1 in LEAK patients (82.8 ± 14.2/min vs 75.1 ± 12.7/min, P = 0.0081) which persisted for the rest of the study. By POD 3, there was a significant increase in respiratory rate (18.0 ± 4.2/min vs 16.5 ± 1.3/min, P = 0.0069) and temperature (37.0 ± 0.4C vs 36.7 ± 0.3C, P = 0.0006) in LEAK patients. C‐reactive protein was significantly higher in LEAK patients from POD 2 (165 ± 95 mg/l vs 121 ± 75 mg/l, P = 0.023). Conclusions Physiological and biochemical changes associated with AL happen very early postoperatively, suggesting that AL may occur within 36 h after surgery, despite much later clinical detection.

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Section: Discussionsupporting

confidence: 82%

Physiological changes after colorectal surgery suggest that anastomotic leakage is an early event: a retrospective cohort study

et al. 2019

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“…A few investigational studies have focused on biochemical analysis of effluents of abdominal drains in patients who underwent colorectal anastomosis. Positive correlations with anastomotic leakage were found for lysozyme activity level and endotoxins [20,21] . The value of these findings in daily clinical practice, however, is probably limited.…”

Section: Discussionmentioning

confidence: 87%

Factors determining delay in relaparotomy for anastomotic leakage after colorectal resection

Doeksen

Tanis²,

Vrouenraets³

et al. 2007

WJG

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AIM:To analyze the time interval ('delay') between the first occurrence of clinical parameters associated with anastomotic leakage after colorectal resection and subsequent relaparotomy. METHODS:In 36 out of 289 consecutive patients with colorectal anastomosis, leakage was confirmed at relaparotomy. The medical records of these patients were retrospectively analysed and type and time of appearance of clinical parameters suggestive of anastomotic leakage were recorded. These parameters inc lude d he ar t rate, body temperature, local or generalized peritoneal reaction, leucocytosis, ileus and delayed gastric emptying. Factors influencing delay of relaparotomy and consequences of delayed recognition and treatment were determined. RESULTS:First documentation of at least one of the predefined parameters for anastomotic leakage was after a median interval of 4 ± 1.7 d after the operation. The median number of days between first parameter(s) associated with leakage and relaparotomy was 3.5 ± 5.7 d. The time interval between the first signs of leakage and relaparotomy was significantly longer when CONCLUSION:An intervening weekend and negative diagnostic imaging reports may contribute to a delay in diagnosis and relaparotomy for anastomotic leakage. That delay was more than two days in two-thirds of the patients.

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“…By measuring sensitive markers of coagulation activation and fibrinolysis, anastomotic leakage may be predicted. Endotoxin concentration in drainage fluid has also been found to be a valuable parameter for the detection of anastomotic leak 30 …”

Section: Discussionmentioning

confidence: 99%

Anastomotic leak in colorectal surgery: A single surgeon’s experience

Isbister

2001

ANZ Journal of Surgery

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175 Detection of Anastomotic Leaks After Colorectal Surgery by Measuring LPS in the Drainage Fluid

Cited by 14 publications

References 0 publications

Physiological changes after colorectal surgery suggest that anastomotic leakage is an early event: a retrospective cohort study

Physiological changes after colorectal surgery suggest that anastomotic leakage is an early event: a retrospective cohort study

Factors determining delay in relaparotomy for anastomotic leakage after colorectal resection

Anastomotic leak in colorectal surgery: A single surgeon’s experience

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