Leakage After Resection and Intraperitoneal Anastomosis for Colorectal Malignancy: Analysis of Risk Factors

Choi, Hok Kwok; Law, Wai‐Lun; Ho, Judy W. C.

doi:10.1007/s10350-006-0703-2

Cited by 214 publications

(152 citation statements)

References 20 publications

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“…Among the last ones, male sex, obesity, malnutrition, hipoalbuminemia, smoking habits, alcohol consumption, leukocytosis, intrasurgical blood transfusion, cardiovascular diseases, chronicle obstructive pulmonary diseases and emergency surgeries in patients presenting two or more of the previews diseases in association are remembered as contributing factors to the dehiscence risk increasing 1,2 .…”

Section: Introductionmentioning

confidence: 99%

Hyperbaric oxygen therapy and mechanical resistence of the colonics anastomosis in rats with peritonitis

et al. 2010

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Purpose:To analyze the effects of hyperbaric oxygen therapy (HBO) on the mechanical resistance of anastomosis performed in rats' distal colon presenting peritonitis induced by ligature and cecal punction using the Total Energy Rupture biomechanical test (ETR). Methods: It was used 45 rats divided into three groups of 15 animals each. In Control Group (CG), it was performed anastomosis in distal colon without peritonitis. In Peritonitis Group (PG), it was performed anastomosis six hours after the induction of peritonitis by ligature and cecal punction. In Hyperbaric Chamber Group (HCG), it was performed six hours after the induction of peritonitis by ligature and cecal punction. The animals on CG and PG were kept at place air while the animals on HCG were placed on an experimental hyperbaric chamber in order to inhale oxygen at 100%, two absolute atmospheres, for 120 minutes, for four consecutive days. Euthanasia took place on the fifth day of the experiment. All the animals underwent to Total Energy Rupture Biomechanical Resistance test (ETR). Total Energy Rupture was defined as the necessary internal energy stored up to promote the colon rupture after an external traction force imposition. Results: The Peritonitis Group presents smaller average ETR than Control Group. There was no statistical difference between Peritonitis Group and Hyberbaric Chamber Group. Conclusion: Hyperbaric oxygen therapy did not alter the mechanical resistance of anastomosis performed in distal colon of rats under the presence of peritonitis induced by ligature and cecal puncture. Key words: Anastomosis, Surgical. Colon. Hyperbaric Oxygenation. Peritonitis. Rats. RESUMO Objetivo:Analisar o efeito da oxigenoterapia hiperbárica (HBO) sobre a resistência mecânica de anastomoses realizadas em cólon distal de ratos na presença de peritonite induzida por ligadura e punção cecal utilizando o teste biomecânico de Energia Total de Ruptura (ETR). Métodos: Foram utilizados 45 ratos distribuídos em três grupos de 15 animais. No Grupo Controle (GC), realizou-se anastomose no cólon distal sem peritonite. No Grupo Peritonite (GP), realizou-se anastomose seis horas após a indução da peritonite por ligadura e punção cecal. No Grupo Câmara Hiperbárica (GCH), realizou-se anastomose seis horas após a indução da peritonite por ligadura e punção cecal. Os animais dos GC e GP foram mantidos em ar ambiente. Os animais do GCH foram colocados em uma câmara hiperbárica experimental para inalarem oxigênio a 100%, a duas atmosferas absolutas, durante 120 minutos, por quatro dias consecutivos. A eutanásia ocorreu no quinto dia do experimento. Todos os animais foram submetidos ao Teste de Resistência Biomecânico Energia Total de Ruptura (ETR). A Energia Total de Ruptura foi definida como a energia interna acumulada necessária para promover o rompimento do cólon após a imposição de uma força externa de tração. Resultados: O Grupo Peritonite apresentou menor média de ETR que o Grupo Controle. Não houve diferença estatística entre o Grupo Peritonite e o Grupo C...

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Section: Introductionmentioning

confidence: 99%

Hyperbaric oxygen therapy and mechanical resistence of the colonics anastomosis in rats with peritonitis

et al. 2010

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“…The incidence of anastomotic leakage after surgery for rectal cancer ranges between 1.8 and 19.8 % [2,3]; however, these rates vary according to the definition used. Higher rates are reported whenever anastomotic leakage is detected by radiology (CT, or gastrografin enema).…”

Section: Discussionmentioning

confidence: 99%

“…Development of the anastomotic leakage is the most feared complication after rectal cancer surgery with incidence in the published literature ranging from 1.8 to 19.8 % [2,3]. Anastomotic leakage leads to significant morbidity to the patient with impact on oncological, clinical, and functional outcomes.…”

Section: Introductionmentioning

confidence: 99%

Analysis of Risk Factors and Management of Anastomotic Leakage After Rectal Cancer Surgery: An Indian Series

Jatal

Pai

Demenezes

et al. 2015

Indian J Surg Oncol

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The primary objective of this study was to determine whether sphincter preservation is possible among patients who develop anastomotic leakage after rectal cancer surgery. The secondary objective was to determine the factors that may contribute to anastomotic leakage. This is a retrospective review of a prospectively maintained database. All patients with rectal cancer who underwent restorative proctectomy over 1 year were included in the study. The parameters analyzed were age, preoperative hemoglobin and albumin, neoadjuvant therapy, type of surgery, level of ligation of inferior mesenteric pedicle, technique of anastomosis, and defunctioning proximal stoma. In this study, 176 cases of anterior resection were included,of which15 (8.5 %) had anastomotic leakage. None of the factors contributing to anastomotic leakage reached statistical significance on univariate analysis. Among the patients who had proximal defunctioning ileostomy (n = 9), five (56 %) required re-surgery whereas other four were managed with antibiotics and presacral drainage alone (44 %). Among the patients who didnot have proximal defunctioning ileostomy (n = 6), all (100 %) required re-surgery. Among the 12 eligible patients, stoma reversal was successful in eight (67 %) patients. This study highlights the importance of defunctioning proximal stoma in reducing the incidence and severity of anastomotic leakage as well as the need and extent of re-surgery for low rectal cancer. Sphincter preservation is possible in majority of patients who develop anastomotic leakage after rectal cancer surgery.

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“…Identified risk factors include male gender [12,13], tumor location and the level of anastomosis [11][12][13]28], steroid use [21], smoking [13,21], intraoperative adverse events [28], the lack of stoma [11,14,15], preoperative chemoradiotherapy or radiotherapy [12,28], severe bleeding [28], higher American Society of Anesthesiologists grade [21,29], and emergency surgery [29].…”

Section: Drain As An Independent Risk Factor Of Anastomotic Leak?mentioning

confidence: 99%

Drain vs No Drain After Colorectal Surgery

Tsujinaka

Konishi

2011

Indian J Surg Oncol

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In colorectal surgery, drains are expected to prevent hematoma, fluid collection, or abscess formation, to act as an indicator of postoperative complication, or to minimize the severity of complication-related symptoms. Routine drainage has not been advocated by meta-analyses as they failed to demonstrate any benefit in reducing anastomotic leak rate, minimizing symptoms, or serving as a warning function. Moreover, some reports even showed that drain itself is an independent risk factor of anastomosis. The introduction of total mesorectal excision (TME) for rectal cancer surgery has given further concern to this controversial issue, that the use of drain decreased anastomotic failure rate and the need for surgical re-intervention. While controversy still remains, the choice of using drain is left to the individual surgeon's preference in daily practice. Therefore, surgeons should be well acquainted with purpose of drainage (prophylaxis, information, or treatment), characteristics (materials), clinical application of drain (type of drainage system, timing of removal), surgical outcomes after using drain (incidence of postoperative complication), and drain-related complications. If drains are used, careful observation with proper use is crucial for the management. It is important that the duration of drainage should not be inadequately extended. Any complications directly associated with the use of drain should be avoided. New concepts of drain have been proposed as diagnostic tool using biomarkers, and as preventive device against anastomotic leak. This article overviews the available, published data on the use of drain in colorectal surgery.

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Leakage After Resection and Intraperitoneal Anastomosis for Colorectal Malignancy: Analysis of Risk Factors

Cited by 214 publications

References 20 publications

Hyperbaric oxygen therapy and mechanical resistence of the colonics anastomosis in rats with peritonitis

Hyperbaric oxygen therapy and mechanical resistence of the colonics anastomosis in rats with peritonitis

Analysis of Risk Factors and Management of Anastomotic Leakage After Rectal Cancer Surgery: An Indian Series

Drain vs No Drain After Colorectal Surgery

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