Intraoperative testing of colorectal anastomosis and the incidence of anastomotic leak

Abstract

Background: AL remains one of the most threatening complications in colorectal surgery. Significant efforts are put to understand the pathophysiological mechanisms involved in the development of leakage and to create the strategies to prevent it. We aimed to determine whether intraoperative testing of mechanical integrity and perfusion of colorectal anastomosis could reduce the incidence of AL. Methods: A systematic review and meta-analysis of papers published before November 2019 on PubMed, Scopus, Web of Science, and Cochrane Library databases and comparing intraoperative testing of the colorectal anastomosis with standard care were conducted. Odds ratios (ORs) and 95% confidence interval (CIs) were used to assess the association between intraoperative testing and AL. Results: A total of 23 studies totaling 7115 patients were included. Pooled analysis revealed intraoperative tests, for integrity (OR 0.52, 95% CI 0.34–0.82, P < .001) and perfusion (OR 0.40, 95% CI 0.22–0.752, P < .001) of the lower gastrointestinal tract anastomoses are associated with significantly lower AL rate. Conclusions: Intraoperative testing for either integrity or perfusion of anastomoses both reduce the AL rate. Studies looking at the combination of these two testing methods of anastomosis, especially intraoperative endoscopy, and indocyanine green fluorescence angiography may be very promising to further reduction of the AL.

Indocyanine green fluorescence‐guided laparoscopic removal of infected mesh with chronic sinus formation after inguinal mesh plug repair

“…Through imaging technology development, intraoperative real‐time fluorescence imaging has been applied to various fields of hepatic, cardiac, ophthalmologic, oncologic surgeries, and so forth 6‐12 . ICG can be visualized under near‐infrared light.…”

“…Near‐infrared light (700‐900 nm) is more advantageous than visible light due to its capability to penetrate deeper into tissue, up to 10 mm 23 . The fluorescent property can help to recognize anatomical structures, analyze tissue perfusion and identify sentinel lymph nodes in intraoperative cancer staging 6‐8,10,11,24 …”

Indociano Žaliojo Fluorescencija Koloproktologijoje. Metodo Apžvalga Ir Pirmosios Patirties Klaipėdos Universitetinėje Ligoninėje Pristatymas

“…Nepaisant technologijų pažangos, anastomozės nesandarumas išlieka rimta ir dažna chirurginė komplikacija [1]. Ne kiekvienu atveju tiksli priežastis gali būti nustatyta, tačiau žinomos būtinos sąlygos jai sugyti -pakankama kraujotaka, jokio tempimo, kuo mažesnis užterštumas, sandarus sujungimas.…”

“…Nors studijų apie žarnų kraujotakos vertinimą publikuota gausiai, didžioji dalis jųsilpni nedidelės apimties atvejų pristatymai. Ribotas kokybiškų studijų kiekis lemia tai, kad skirtingos metaanalizės nagrinėja tas pačias studijas, todėl ir išvados didžiąja dalimi sutampa (1 lentelė) [1,3,13].…”

Utilidad de la revisión endoscópica intraoperatoria en las anastomosis digestivas

“…Finalmente, en 2020, Krzauskas et al 29 podrían haber esclarecido esta controversia, al menos en las anastomosis colorrectales, al realizar un metaanálisis en el cual incluyeron 12 estudios con 3,787 pacientes, a los cuales realizaron prueba de fuga aérea aislada, CIO con prueba de fuga aérea y CIO con fuga aérea e instilación de solución salina teñida de azul. Este metaanálisis comprende dos estudios controlados y aleatorizados, los cuales reportaron una prueba de endoscopia intraoperatoria positiva en el 23-25% de los pacientes y sus tasas finales de fuga anastomótica Por otro lado, los estudios observacionales incluidos en el metaanálisis reportaron una tasa de pruebas de fuga aérea positivas que varió del 1.2 al 18.8%, con tasas de fuga anastomótica en el grupo de estudio del 0-10%, contra el 1.5-12.1% en el grupo control.…”