Diagnostic Value of Serial Measurement of C-Reactive Protein in the Detection of a Surgical Complication after Laparoscopic Bowel Resection for Endometriosis

Abstract

Aims: The study aimed to assess the diagnostic value of serial monitoring of biochemical inflammatory markers (C-reactive protein (CRP) and white blood cell (WBC) count) in the postoperative diagnosis of anastomotic leakage or ureteral injury after bowel resection for deep infiltrating endometriosis. Methods: This is a review of prospectively collected data from 217 patients who underwent laparoscopic bowel resection for endometriosis from January 2009 to April 2015. Patients with an anastomotic leakage or ureteral injury were identified and classified. Results: The frequency of anastomotic leakage requiring reoperation was 8.3%. The frequency of ureteral injury was 4.6%. Median time to diagnosis was 6 days for anastomotic leakage and 8 days for ureteral injury. The daily mean values of serum CRP were significantly higher in patients with a surgical complication starting at the second postoperative day (POD 2, p = 0.004). WBC was significantly higher (p < 0.05) on POD 2 and 3 in patients with a surgical complication. A decrease in CRP from POD 1 to 3 predicted an uncomplicated course in 92.1% of the cases. Conclusion: A decrease in CRP from POD 1 to 3 was an indicator of uncomplicated subsequent postoperative course. The test is recommended when early discharge after rectal resection for deep infiltrating endometriosis is considered.

C‐reactive protein assessment to predict early septic complications after laparoscopic bowel resection for endometriosis: a diagnostic study

“…Finally, the unsurprisingly differing conclusions of that study were first based on a rate of septic complications (32%) three‐fold higher than that reported in our series and secondly on characteristics of patients managed for other colorectal diseases most likely considerably different from those of young women with colorectal endometriosis. This lends support to the need for studies which focus exclusively on endometriosis disease …”

“…These women had undergone temporary diverting stoma with a preventive diverting stoma performed at the end of the first surgery for one patient (16.67%), and for five patients (83.3%) an emergency stoma was performed during a second procedure. The diagnosis of postoperative leakage was noted after a median length of time of 5.5 days . The peak in WBC level was recorded on day 4 with a median level at 16 250/mm 3 , which was statistically higher than that in patients free of complications ( P < 0.0001).…”

“…Although previous studies have assessed the CRP predictive value for postoperative complications, these have generally focused on patients managed by open surgery, where the risk of postoperative septic complications may be different compared with that associated with laparoscopic procedures. One valuable study reported on the association between CRP values at postoperative days 1–3, but such early CRP monitoring would fail to detect septic complications occurring later, at days 4–6 …”

“…C‐reactive protein (CRP) is a sensitive, cost‐effective, but non‐specific serum marker for inflammation. An increase in CRP level may precede clinical manifestations of infections; accordingly, several studies have noted C‐reactive protein as an early predictor of intra‐abdominal septic complications following various colorectal procedures …”

“…An increase in CRP level may precede clinical manifestations of infections; accordingly, several studies have noted C-reactive protein as an early predictor of intra-abdominal septic complications following various colorectal procedures. [4][5][6][7][8][9][10][11] The aim of this study was to assess the value of C-reactive protein values for the prediction of septic pelvic complications secondary to laparoscopic bowel excision or resection for endometriosis.…”