Diagnostik und Definition der Nahtinsuffizienz aus chirurgischer Sicht

Abstract

The leak rates of different gastrointestinal anastomoses vary considerably but despite this there are common and general concepts for diagnosis and management. Early diagnosis and timely consistent therapy must guide management to prevent harm to the patients. Diagnosis of anastomotic leaks is coupled to clinical signs of the patients and should be initiated promptly. Dependent on the localization of the leak, computed tomography with administration of oral or rectal contrast dye and endoscopy are of high diagnostic value. Both procedures guarantee the option of drainage or stenting through interventional drains or stent placement. Only the implementation of uniform definitions of anastomotic leaks enables surgeons to compare and to improve surgical treatment. Over recent years consensus definitions of postoperative complications including bile leak, pancreatic fistula and colorectal leak have been formulated. These definitions are based on a 3-fold increase of bilirubin (bile leak) or amylase levels (pancreatic fistula) in abdominal drainage fluid compared to serum levels or on an intestinal wall defect with communication of the intraluminal and extraluminal compartments (colorectal anastomosis). The definitions each describe three severity grades A-C. A change of clinical management is required in grade B whereas grade C usually requires a re-operation. Comparable consensus definitions for anastomotic leaks following esophagogastrostomy or esophagojejunostomy or following small bowel anastomosis have not been established. The authors strongly recommend implementation of the presented consensus definitions into clinical and academic daily practice.

The use of over-the-scope clip in the treatment of persistent staple line leak after re-sleeve gastrectomy: Review of the literature

“…Based on both clinical and radiological findings, Type A classification includes microperforations without clinical or radiographic evidence of leak, Type B represents leaks detected by radiological studies without any clinical finding, Type C leaks are both radiological and clinical apparent. [678] In our case, the patient presented with a late, Type II, Type C leak after re-sleeve.…”

Ghost Ileostomy with or without abdominal parietal split

“…In fact, covering stoma (ileostomy or colostomy) is characterized by major complications related to the procedure, longer recovery time, necessity of a re-intervention under general anesthesia for stoma closure and worse quality of life [2,14]. …”

“…The International Study Group of Rectal Cancer defines anastomotic leak as a "defect of the intestinal wall integrity at the colorectal or colo-anal anastomotic site (including suture and staple lines of neorectal reservoirs) leading to a communication between the intra- and extraluminal compartments [14-16]. The International Study Group of Rectal Cancer has also defined the grade of anastomotic leak in relation to the treatment [17]; the risk of re-intervention for permanent stoma after anastomotic leak is very high (25%) [18].…”

Pancreatic Remnant Occlusion after Whipple's Procedure: An Alternative Oncologically Safe Method

“…Postoperative mortality rate has decreased significantly in comparison to the previous years and is reported below 5% in high volume centers [6], but morbidity is still considered high. Anastomotic leakage at the pancreaticojejunostomy is one of the most severe complications of PD with 5–25% rate among series according to different definitions [7, 8], leading to prolonged hospital stay, interventional radiology procedures, relaparotomy, and high mortality rates. Many anastomotic techniques have been described in order to prevent leakage from the pancreatic anastomosis, but unfortunately with no uniform results [9].…”