Intraoperative air testing of colorectal anastomoses

Abstract

In our opinion, intraoperative air testing of colorectal anastomosis is a good method for prevention of anastomotic dehiscence.

Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks

“…Of note, the highest clinical leak rates occurred in patients with a positive air‐leak test who had suture repair alone (12·2 per cent); rates were zero among patients who had faecal diversion or reanastomosis. Furthermore, a study in 2011 demonstrated a trend towards lower leak rates with air‐leak testing; however, the study was underpowered.…”

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

“…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.…”

“…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].…”

“…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.…”

A novel powered circular stapler designed for creating secure anastomoses

“…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]. Based on these observations we have chosen 30 mmHg as a reasonable leak pressure criteria to assess the quality of a circular stapler in creating a secure anastomosis.…”