Intraoperative air testing of colorectal anastomoses: A prospective, randomized trial

Abstract

A total of 145 consecutive patients receiving a colorectal anastomosis were randomized to 'test' or 'no test' once the anastomosis had been completed. Anastomotic testing was performed with the pelvis filled with saline and the rectum distended by sigmoidoscopic insufflation of air. Any leaks demonstrated were oversewn. A water-soluble contrast enema was performed on the tenth postoperative day. Seventy-four patients were randomized to 'test' and 71 to 'no test' but one patient was withdrawn from each group leaving a total of 143 for analysis. The two groups were well matched for age, sex, diagnosis and operative details. Eighteen (25 per cent) air leaks were detected and repaired in the 'test' group. After operation there were three (4 per cent) clinical leaks in the 'test' group and ten (14 per cent) in the 'no test' group (Fisher's exact test, P = 0.043). There were eight (11 per cent) radiological leaks in the 'test' group and 20 (29 per cent) in the 'no test' group (P = 0.006). Intraoperative air testing and repair of colorectal anastomoses significantly reduces the risk of postoperative clinical and radiological leaks.

The Syringe Test to Determine the Integrity of Intestinal Anastomoses

“…1 We find that the use of this retractorc an damage thea rticulars urfaceo ft he humeralh ead and interferes with theoperative field. We describe an alternativemethod that avoids these complications.…”

A novel powered circular stapler designed for creating secure anastomoses

“…One early study recommended a pressure of 25 cm saline (18.4 mmHg) as being sufficient to detect leaks while being within physiological limits [26]. Another study found that intrarectal pressure could not be raised above 35 mm Hg because of venting of air [27]. Insufflation is typically performed until the rectum is 'optimally' distended, which may be limited by air leak along the sigmoidoscope [28].…”

Successful Management of a Positive Air Leak Test during Laparoscopic Colorectal Surgery

“…Some reports recommended intraoperative repair of stapled anastomotic defects using interrupted sutures as a safe alternative to a diverting colostomy or ileostomy [7,10]. On the other hand, Ricciardi et al [11] suggested that suture repair alone in the setting of a positive air leak results in postoperative CAL because the postoperative clinical leak rate (12.2%) in their patients was significantly higher than the rate (3.8%) in anastomosis with initially negative intraoperative leak test results [11].…”

“…Among these, the air leak test (ALT) is reportedly the most frequently performed intraoperative test to identify a mechanically insufficient anastomosis [6]. A randomized prospective study of the intraoperative ALT showed significant reduction of postoperative leakage in the tested group [7]. Direct insufflation of air at the level of the anastomosis by intraoperative colonoscopy (IOCS) may be reliable for ensuring adequate intraluminal pressure to demonstrate a leak.…”