Endoscopic Intraoperative Anastomotic Testing May Avoid Early Gastrointestinal Anastomotic Complications. A Prospective Study

Lieto, Eva; Orditura, Michele; Castellano, Paolo; Pinto, Margherita; Zamboli, Anna; Vita, Ferdinando De; Pignatelli, Carlo; Galizia, Gennaro

doi:10.1007/s11605-010-1371-z

Cited by 27 publications

(26 citation statements)

References 22 publications

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“…Lieto et al . and Shamiyeh et al . introduced intra‐operative FE on a routine basis which raises concerns for selection bias when comparing the reported leak rate to other studies.…”

Section: Resultsmentioning

confidence: 92%

Does intra‐operative flexible endoscopy reduce anastomotic complications following left‐sided colonic resections? A systematic review and meta‐analysis

et al. 2019

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Aim Postoperative anastomotic leakage (AL) or bleeding (AB) significantly impacts on patient outcome following colorectal resection. To minimize such complications, surgeons can utilize different techniques perioperatively to assess anastomotic integrity. We aim to assess published anastomotic complication rates following left‐sided colonic resection, comparing the use of intra‐operative flexible endoscopy (FE) against conventional tests used to assess anastomotic integrity. Methods PubMed/MEDLINE and Embase online databases were searched for non‐randomized and randomized case–control studies that investigated postoperative AL and/or AB rates in left‐sided colonic resections, comparing intra‐operative FE against conventional tests. Data from eligible studies were pooled, and a meta‐analysis using Review Manager 5.3 software was performed to assess for differences in AL and AB rates. Results Data from six studies were analysed to assess the impact of FE on postoperative AL and AB rates (1084 and 751 patients respectively). Use of FE was associated with reduced postoperative AL and AB rates, from 6.9% to 3.5% and 5.8% to 2.4% respectively. Odds ratios favoured intra‐operative FE: 0.37 (95% CI 0.21–0.68, P = 0.001) for AL and 0.35 (95% CI 0.15–0.82, P = 0.02) for AB. Conclusion This meta‐analysis showed that the use of intra‐operative FE is associated with a reduced rate of postoperative AL and AB, compared to conventional anastomotic testing methods.

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“…Lieto et al . and Shamiyeh et al . introduced intra‐operative FE on a routine basis which raises concerns for selection bias when comparing the reported leak rate to other studies.…”

Section: Resultsmentioning

confidence: 92%

Does intra‐operative flexible endoscopy reduce anastomotic complications following left‐sided colonic resections? A systematic review and meta‐analysis

et al. 2019

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“…The thirteen reviewed studies included a total of N=3,023 patients (Table 3), [16,17,[19][20][21][22][23][24][25][26][27][28][29]. Study sample size and design was variable.…”

Section: Resultsmentioning

confidence: 99%

“…Suture repair (74.7%) was the most common method of anastomosis correction used followed by takedown and re-anastomosis (17.3%) and diversion (8.0%). No significant differences in intraoperative leak rates were found were found across anastomosis types (staple: 4.9%, suture: 2.3%, and compression: 0.0%, p=0.066) in the 10 studies that reported leak based on type of anastomosis employed [16,[19][20][21][22][24][25][26][27][28]. Six articles reported on the rate of intraoperative leaks by surgical technique used (laparoscopic v. open) [22,[25][26][27][28][29].…”

Section: Search Term Description Definitionmentioning

confidence: 93%

“…Hand sewn sutured anastomosis was used in a total of n=273 cases (9.0%) and a compression anastomosis was employed in the remaining n=38 cases (1.3%). Seven studies required that staple anastomosis be employed [20][21][22][24][25][26][27], while the remaining six studies allowed multiple methods of anastomosis closure. Within these six studies that employed multiple anastomosis methods [16,19,23,[28][29][30], stapled anastomosis was always one of the methods used.…”

Section: Search Term Description Definitionmentioning

confidence: 99%

“…The study by Chen et al, was excluded from this assessment of post-operative leak rate by study type, as the number of total post-operative leaks were not presented for anastomosis subgroups. Seven articles reported on the rate of post-operative leaks by surgical technique [19,22,[25][26][27][28][29]. In the sample of n=1,589 cases the majority of procedures (55.2%) were performed using laparoscopic techniques.…”

Section: Search Term Description Definitionmentioning

confidence: 99%

See 2 more Smart Citations

Intra-Operative Anastomotic Leak Rates and Testing Methodology in Colorectal Resection Surgery

Schiff¹,

Brady²,

Ghosh³

et al. 2016

J Surg Surgical Res

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048 AbstractPurpose: Anastomotic leak following colorectal resection surgery is associated with high rates of morbidity, infection, and escalated healthcare expenditures. One method to prevent leaks includes early detection through intra-operative testing. This study employed systematic review of the literature to estimate the rate of intra-operative anastomotic leaks in colorectal resection surgery. Method:The Medline and Embase databases were searched to identify articles published between January 1 st , 2003 and August 8 th , 2015 reporting on intra-operative leaks in colorectal resection. The rate of intra-operative testing, intra-and post-operative anastomotic leaks, and surgical methodology were extracted from the final sample of 13 articles.Results: A total of 167 intra-operative leaks were reported within 2,598 colorectal resection surgeries that used intra-operative testing, yielding an average leak rate of 6.4%. Use of laparoscopic techniques was significantly associated with a reduced rate of intra-operative leak (p<0.001). Eight articles reported on the rate of post-operative anastomotic leak in relation to intraoperative testing. Within this sample of 2,098 cases a non-significant trend towards a lower leak rate in the tested population was identified (4.3% v. 6.8%, p=0.051); cases whose leak test was initially positive exhibited a significantly higher rate of post-operative leaks compared to cases with a negative leak test (p=0.006). Conclusion:Intra-operative anastomotic leak testing allows surgeons to address leaks at the time of surgery, and may help to prevent complications in colorectal resection surgery. This study identified a mean intra-operative leak rate of 6.4% in colorectal resection surgery.

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Intraoperative Air Leak, Colonic Ischemia, or Tension: How to Salvage the Failed Anastomosis

Shaffer

McLemore

2019

The SAGES Manual of Colorectal Surgery

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Endoscopic Intraoperative Anastomotic Testing May Avoid Early Gastrointestinal Anastomotic Complications. A Prospective Study

Abstract: Endoscopic anastomotic testing was a safe and reliable method to assess integrity of gastrointestinal anastomoses, to correct any defect under direct visualization, and to avoid early complications. However, this method seemed inadequate to predict late anastomotic complications.

Cited by 27 publications

References 22 publications

Does intra‐operative flexible endoscopy reduce anastomotic complications following left‐sided colonic resections? A systematic review and meta‐analysis

Does intra‐operative flexible endoscopy reduce anastomotic complications following left‐sided colonic resections? A systematic review and meta‐analysis

Intra-Operative Anastomotic Leak Rates and Testing Methodology in Colorectal Resection Surgery

Intraoperative Air Leak, Colonic Ischemia, or Tension: How to Salvage the Failed Anastomosis

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