Prediction and diagnosis of colorectal anastomotic leakage: A systematic review of literature

Abstract

Although many studies have focused on the preoperative risk factors of anastomotic leakage after colorectal surgery (CAL), postoperative delay in diagnosis is common and harmful. This review provides a systematic overview of all available literature on diagnostic tools used for CAL. A systematic search of literature was undertaken using Medline, Embase, Cochrane and Web-of-Science libraries. Articles were selected when a diagnostic or prediction tool for CAL was described and tested. Two reviewers separately assessed the eligibility and level of evidence of the papers. Sixty-nine articles were selected (clinical methods: 11, laboratory tests: 12, drain fluid analysis: 12, intraoperative techniques: 22, radiology: 16). Clinical scoring leads to early awareness of probability of CAL and reduces delay of diagnosis. C-reactive protein measurement at postoperative day 3-4 is helpful. CAL patients are characterized by elevated cytokine levels in drain fluid in the very early postoperative phase in CAL patients. Intraoperative testing using the air leak test allows intraoperative repair of the anastomosis. Routine contrast enema is not recommended. If CAL is clinically suspected, rectal contrast-computer tomography is recommended by a few studies. In many studies a "no-test" control group was lacking, furthermore no golden standard for CAL is available. These two factors contributed to a relatively low level of evidence in the majority of the papers. This paper provides a systematic overview of literature on the available tools for diagnosing CAL. The study shows that colorectal surgery patients could benefit from some diagnostic interventions that can easily be performed in daily postoperative care.

Clinical Endpoint, Early Detection, and Differential Diagnosis of Postoperative Ileus: A Systematic Review of the Literature

“…Our review shows that CT with Gastrografin provided the most reliable differential diagnosis between POI and mechanical obstruction (LOE: 1c) [25]. Our previous systematic review regarding the detection of anastomotic leakage also demonstrated it to be a reliable diagnostic tool [41], which may assist the differential diagnosis between POI and septic ileus, due to anastomotic leakage by radiological manifestations such as the existence of extraluminal contrast, perianastomotic air, and fluid collections in the CT scan as adjuvants to the clinical manifestations and laboratory tests [42,43]. These integrated results suggest that CT scan should be recommended when suspicion is aroused.…”

Diagnostic Value of Serial Measurement of C-Reactive Protein in the Detection of a Surgical Complication after Laparoscopic Bowel Resection for Endometriosis

“…Previous abdominal surgery has been shown to be a risk factor for conversion to laparotomy in patients undergoing colorectal resection, but it did not seem to increase the risk of an anastomotic leakage [19] . Early diagnosis of these complications potentially minimizes the inflammatory tissue reactions thereby facilitating repair and healing [20] .…”

Transanal total mesorectal excision for rectal cancer: a preliminary report

“…As previously mentioned, the most challenging part of pTaTME is to ligate IMV and mobilize proximal colon and MSF. Moreover, methods adopted to prevent disastrous anastomotic leak (AL) such as protective stoma [32] and air leak test [33] are inconvenient to perform. Consequently, it raises concerns about increased Als in pTaTME cases.…”