Small bowel anastomosis in peritonitis compared to enterostomy formation: a systematic review

Skovsen, Anders Peter; Burcharth, Jakob; Gögenur, Ismail; Tolstrup, Mai-Britt

doi:10.1007/s00068-022-02192-7

Cited by 4 publications

(7 citation statements)

References 47 publications

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“…13 In a recent systematic review of small bowel anastomoses in peritonitis, the anastomotic leak rate varies from 0% to 36%. 8 Compared to elective surgery, the rate of anastomotic leak in our current study is low; in 2021, a national database reported a leak rate of 1.7% in elective right hemicolectomies for colonic cancer. 14 Carcinomatosis peritonei was discovered in seven patients.…”

Section: Discussionmentioning

confidence: 51%

“…In the WSES guidelines, performing an ileostomy should be reserved for delayed operations with friable tissue and is considered a life‐saving alternative to a primary anastomosis 13 . In a recent systematic review of small bowel anastomoses in peritonitis, the anastomotic leak rate varies from 0% to 36% 8 . Compared to elective surgery, the rate of anastomotic leak in our current study is low; in 2021, a national database reported a leak rate of 1.7% in elective right hemicolectomies for colonic cancer 14…”

Section: Discussionmentioning

confidence: 54%

“…Peritonitis has long been considered a risk factor for anastomotic leakage when performing a bowel resection, and thus a relative contraindication for performing a bowel anastomosis 5 . There is low quality evidence to guide the decision of a primary anastomosis when performing a small‐bowel anastomosis or a small‐bowel to large‐bowel anastomosis in emergency surgery, but it appears safe 8 …”

Section: Introductionmentioning

confidence: 99%

“…5 There is low quality evidence to guide the decision of a primary anastomosis when performing a small-bowel anastomosis or a small-bowel to large-bowel anastomosis in emergency surgery, but it appears safe. 8 The purpose of this study was to examine the rate of anastomosis, the complication rate and safety of smallbowel anastomoses in emergency abdominal surgery. Secondarily to identify risk factors for anastomotic leakage.…”

Section: Introductionmentioning

confidence: 99%

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Small bowel anastomosis in emergency surgery

Skovsen,

Korgaard Jensen,

Gögenur

et al. 2024

World j. surg.

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BackgroundEmergency laparotomy is associated with a high morbidity and mortality rate. The decision on whether to perform an anastomosis or an enterostomy in emergency small bowel resection is guided by surgeon preference alone, and not evidence based. We examined the risks involved in small bowel resection and anastomosis in emergency surgery.MethodsA retrospective study from 2016 to 2019 in a university hospital in Denmark, including all emergency laparotomies, where small‐bowel resections, ileocecal resections, right hemicolectomies and extended right hemicolectomies where performed. Demographics, operative data, anastomosis or enterostomy, as well as postoperative complications were recorded. Primary outcome was the rate of bowel anastomosis. Secondary outcomes were the anastomotic leak rate, mortality and complication rates.ResultsDuring the 3.5‐year period, 370 patients underwent emergency bowel resection. Of these 313 (84.6%) received an anastomosis and 57 (15.4%) an enterostomy. The 30‐day mortality rate was 12.7% (10.2% in patients with anastomosis and 26.3% in patients with enterostomy). The overall anastomotic leak rate was 1.6%, for small‐bowel to colon 3.0% and for small‐bowel to small‐bowel 0.6%.ConclusionA primary anastomosis is performed in more than eight out of 10 patients in emergency small bowel resections and is associated with a very low rate of anastomotic leak.

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Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 54%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Small bowel anastomosis in emergency surgery

Skovsen,

Korgaard Jensen,

Gögenur

et al. 2024

World j. surg.

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“…Загальні показники смертності хворих становили 0-20 %, а показники неспроможності анастомозу -0-36 %. Після проведення оцінки ризику упередження не було підстав для проведення мета-аналізу, а якість доказів була оцінена як низька, щоб назвати перитоніт фактором ризику неспроможності анастомозу при лапаротомії з резекцією тонкої кишки [22].…”

Section: результати дослідження та їх обговоренняunclassified

Features of Choice of Operative Tactics for Acute I Ntestinal Obstruction and Diffused Peritonitis

Olefir¹

2023

Khark. Surg. Sch.

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Summary. The aim of the study was to evaluate and compare the early postoperative outcomes of patients with GKN who received either primary anastomosis or only stoma formation after bowel resection with the identification of factors associated with postoperative complications and mortality in both groups of patients. Materials and methods. The study included 63 patients with acute intestinal obstruction and peritonitis who underwent resection of the small intestine followed by the formation of a jejunostomy. The factors affecting the choice of the option of completing the surgical intervention were studied. Research results. Under relatively equal conditions, after resection of the small intestine in patients with acute intestinal obstruction and peritonitis other than vascular etiology, preference should be given to interintestinal anastomoses with a Meidl jejunostomy for the purpose of «unloading», when obstruction caused by vascular pathology is detected — the preference is on the side temporary terminal uenostomy with staged interventions according to indications. Conclusions. After resection of the small intestine in case of non-vascular etiology, preference should be given to interintestinal anastomosis or Y-shaped anastomosis according to Meidl. The only risk factor for mortality is postoperative multiple organ failure.

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Reduced preoperative serum choline esterase levels and fecal peritoneal contamination as potential predictors for the leakage of intestinal sutures after source control in secondary peritonitis

Amati,

Ebert,

Maier

et al. 2024

World J Emerg Surg

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Background The high rate of stoma placement during emergency laparotomy for secondary peritonitis is a paradigm in need of change in the current fast-track surgical setting. Despite growing evidence for the feasibility of primary bowel reconstruction in a peritonitic environment, little data substantiate a surgeons’ choice between a stoma and an anastomosis. The aim of this retrospective analysis is to identify pre- and intraoperative parameters that predict the leakage risk for enteric sutures placed during source control surgery (SCS) for secondary peritonitis. Methods Between January 2014 and December 2020, 497 patients underwent SCS for secondary peritonitis, of whom 187 received a primary reconstruction of the lower gastro-intestinal tract without a diverting stoma. In 47 (25.1%) patients postoperative leakage of the enteric sutures was directly confirmed during revision surgery or by computed tomography. Quantifiable predictors of intestinal suture outcome were detected by multivariate analysis. Results Length of intensive care, in-hospital mortality and failure of release to the initial home environment were significantly higher in patients with enteric suture leakage following SCS compared to patients with intact anastomoses (p < 0.0001, p = 0.0026 and p =0.0009, respectively). Reduced serum choline esterase (sCHE) levels and a high extent of peritonitis were identified as independent risk factors for insufficiency of enteric sutures placed during emergency laparotomy. Conclusions A preoperative sCHE < 4.5 kU/L and generalized fecal peritonitis associate with a significantly higher incidence of enteric suture insufficiency after primary reconstruction of the lower gastro-intestinal tract in a peritonitic abdomen. These parameters may guide surgeons when choosing the optimal surgical procedure in the emergency setting.

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Small bowel anastomosis in peritonitis compared to enterostomy formation: a systematic review

Cited by 4 publications

References 47 publications

Small bowel anastomosis in emergency surgery

Small bowel anastomosis in emergency surgery

Features of Choice of Operative Tactics for Acute I Ntestinal Obstruction and Diffused Peritonitis

Reduced preoperative serum choline esterase levels and fecal peritoneal contamination as potential predictors for the leakage of intestinal sutures after source control in secondary peritonitis

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