Systematic review of methods to predict and detect anastomotic leakage in colorectal surgery

Hirst, N. A.; Tiernan, James; Millner, Paul A.; Jayne, David

doi:10.1111/codi.12411

Cited by 131 publications

(112 citation statements)

References 84 publications

Supporting

Mentioning

109

Contrasting

Unclassified

Order By: Relevance

“…The low sensitivity of these often-used diagnostic methods has been confirmed in other studies [28, 38, 39]. When the CT scan was positive for leakage, it took 8.5 days in mean before leakage was confirmed, compared to 4.3 days in patients who were diagnosed during a reoperation.…”

Section: Discussionmentioning

confidence: 79%

Diagnosis, treatment, and consequences of anastomotic leakage in colorectal surgery

Gessler

Eriksson

Angenete

2017

Int J Colorectal Dis

201

156

View full text Add to dashboard Cite

PurposeThe aim of this study was to explore the choice of modality for diagnosis, treatments, and consequences of anastomotic leakage.MethodsThis is a retrospective study of consecutive patients who underwent surgery that included a colorectal anastomosis due to colorectal cancer, diverticulitis, inflammatory bowel disease (IBD), or benign polyps.ResultsA total of 600 patients were included during 2010–2012, and 60 (10%) had an anastomotic leakage. It took in mean 8.8 days (range 2–42) until the anastomotic leakage was diagnosed. A total of 44/60 of the patients with a leakage had a CT scan of the abdomen; 11 (25%) were initially negative for anastomotic leakage. Among all leakages, the anastomosis was taken down in 45 patients (76.3%). All patients with a grade B leakage (n = 6) were treated with antibiotics, and two also received transanal drainage. The overall complication rate was also significantly higher in those with leakage (93.3 vs. 28.5%, p < 0.001), and it was more common with more than three complications (70 vs. 1.5%, p < 0.001). There was a higher mortality in the leakage group.ConclusionThis study demonstrated that one fourth of the CT scans that were executed were initially negative for leakage. Most patients with a grade C leakage will not have an intact anastomosis. An anastomotic leakage leads to significantly more severe postoperative complications, higher rate of reoperations, and higher mortality. An earlier relaparotomy instead of a CT scan and improved postoperative surveillance could possibly reduce the consequences of the anastomotic leakage.

show abstract

Section: Discussionmentioning

confidence: 79%

Diagnosis, treatment, and consequences of anastomotic leakage in colorectal surgery

Gessler

Eriksson

Angenete

2017

Int J Colorectal Dis

201

156

View full text Add to dashboard Cite

show abstract

“…Nevertheless, it is necessary to notice that due to a case-control design, these studies contain a potential risk of overestimation of the test sensitivity. These inflammatory cytokines will also increase in other inflammatory or infectious complications such as anastomotic leakage and peritonitis [36], and an increased procalcitonin level was also found in patients with ischemic bowel obstruction [37]. An abnormal level of these cytokines may have more importance as a general alert for postoperative complications, warning surgeons to take necessary interventions.…”

Section: Discussionmentioning

confidence: 99%

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

Wu¹,

Boersema²,

Dereci³

et al. 2014

Eur Surg Res

View full text Add to dashboard Cite

Background: This systematic review summarizes evidence regarding clinical endpoints, early detection, and differential diagnosis of postoperative ileus (POI). Methods: Using MEDLINE, EMBASE, Cochrane, and Web-of-Science, we identified 2,084 articles. Risk of bias and level of evidence (LOE) of the included articles were determined, and relevant results were summarized. Results: Eleven articles were included, most of which with substantial risks of bias. Bowel motility studies revealed that defecation together with solid food tolerance is the most representative clinical endpoint of POI (LOE: 2b); other clinical signs (e.g. bowel sounds, passage of flatus) did not correlate with a full recovery of bowel motility. Inflammatory parameters including interleukin (IL)-6, IL-1, and TNF-α might assist in an early detection of prolonged POI (LOE: 4). Clinical manifestations (e.g. nausea, vomiting, abdominal distension, bowel sounds, flatus) and X-ray examinations provided limited aid to the differential diagnosis of POI, while CT with Gastrografin had the best specificity and sensitivity (both 100%; LOE: 1c). Conclusions: Postoperative defecation together with tolerance of solid food intake seems to be the best clinical endpoint of POI. CT has the best differential diagnostic value between POI and other complications. Prospective studies with a high LOE are in great need. © 2014 S. Karger AG, Basel

show abstract

“…Current modalities include intraoperative techniques such as direct endoscopic visualization, air leak testing, tissue oxygenation assessment, and radiologic techniques including computerized tomography and water soluble contrast enema. Despite the many modalities, there is insufficient evidence to suggest the most appropriate and reliable diagnostic tool for early detection of an anastomotic leaks [26].…”

Section: Discussionmentioning

confidence: 99%

Malpractice in colorectal surgery: a review of 122 medicolegal cases

Gordhan

Anandalwar

Son

et al. 2015

Journal of Surgical Research

View full text Add to dashboard Cite

Systematic review of methods to predict and detect anastomotic leakage in colorectal surgery

Cited by 131 publications

References 84 publications

Diagnosis, treatment, and consequences of anastomotic leakage in colorectal surgery

Diagnosis, treatment, and consequences of anastomotic leakage in colorectal surgery

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

Malpractice in colorectal surgery: a review of 122 medicolegal cases

Contact Info

Product

Resources

About