The novel appearance of low rectal anastomosis on contrast enema following laparoscopic anterior resection: discriminating anastomotic leaks from “dog-ears” on water-soluble contrast enema and flexible sigmoidoscopy

Katory, Mark; McLean, Ross; Osman, Khalid A.; Ahmad, Mukhtar; Hughes, Tracey; Newby, Mike; Dennison, Christopher R.; O’Loughlin, Paul

doi:10.1007/s00261-016-0885-6

Cited by 15 publications

(16 citation statements)

References 12 publications

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“…The results of our study showed that PC did not reduce the overall incidence of AL (11.3% vs. 9.2%, respectively p = .414) but contributed to fewer Clavien–Dindo III–IV complications, mainly due to the increased risk of second operation and peritonitis after AL. AL is presumably associated with tissue ischemia surrounding the anastomotic area, tenderness of the anastomotic site, 25 increased intraluminal pressure, 26 the “dog ear” of the distal staple liners, 27 and early defecation 28 . Therefore, AL is a multifactorial complication, and altering the individual variable of performing PC or was not enough to change its incidence.…”

Section: Discussionmentioning

confidence: 99%

Short‐term outcomes of pelvic floor peritoneum closure in endoscopic low anterior resection of rectal cancer: A propensity score matching analysis

Gao

Hongchang

et al. 2020

Journal of Surgical Oncology

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Background: The efficacy of pelvic floor peritoneum closure (PC) during endoscopic low anterior resection (E-LAR) of rectal cancer remains unclear. This study aimed to clarify whether pelvic floor PC affected short-term outcomes. Methods: The study group comprised patients with the pathologically confirmed diagnosis of rectal cancer who underwent E-LAR with pelvic floor PC or with no PC (NPC) between January 2013 and December 2018 in Southwest Hospital. After propensity score matching (PSM), 584 patients (292 who underwent PC and 292 who underwent NPC) were evaluated. Postoperative indicators, including the rates of complications, anastomotic leakage (AL), reoperation, and inflammation, were observed in the two groups. Results: No significant difference was observed in the rates of postoperative complications between the PC and NPC groups. The rates of AL were similar (11.3% vs. 9.2%, p = .414). However, the reoperation rate of patients in the PC group was significantly lower than that of patients in the NPC group after AL (36.4% vs. 11.1%, p = .025). The hospital costs were higher in the NPC leakage subgroup (p = .001). Additionally, the serum C-reactive protein levels were lower in the PC group on postoperative days (PODs) 1, 3, and 5, whereas procalcitonin levels on POD 1 and 3 were lower in the PC group but did not differ significantly on POD 5. Conclusion: Pelvic peritonization did not affect the rate of complications, especially AL; however, it effectively reduced the reoperation and inflammation rates and reduced hospitalization costs. Other short-term outcomes were similar, which warrant the increased use of pelvic peritonization in endoscopic surgery.

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Section: Discussionmentioning

confidence: 99%

Short‐term outcomes of pelvic floor peritoneum closure in endoscopic low anterior resection of rectal cancer: A propensity score matching analysis

Gao

Hongchang

et al. 2020

Journal of Surgical Oncology

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“…The incidence of anastomotic leak following the index operation in this cohort was nine (5.8%), which is low 4,15 . The median LOS after ileostomy reversal was 4.2 days (IQR 3.2–8.0) and again was lower than reported 16,17 .…”

Section: Discussionmentioning

confidence: 60%

Investigations and time trends in loop ileostomy reversals following anterior resections: a single Australian institution seven‐years' experience

Taylor

Besson

Faragher

et al. 2020

ANZ Journal of Surgery

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Background Currently no consensus exists regarding what pre‐reversal investigations are required to assess integrity of the rectal anastomosis. The objective of this study was to compare pre‐reversal assessments of anastomotic integrity and to evaluate trends that might have influenced timings for reversal. Methods From a prospectively maintained database, patients with colorectal cancer resections between March 2012 and October 2019 were identified. Patient characteristics, pre‐reversal contrast enema and flexible sigmoidoscopy findings were recorded, and management of complications were recorded. Time‐to‐ileostomy reversal and time series for trends were analysed. Results There were 154 patients included. Pre‐reversal contrast enema or sigmoidoscopy detected a possible stricture or leak at the rectal anastomotic site in 11% (15/132) and 15% (18/112), respectively. When both modalities were used there was concordance of 86.1% and a positive likelihood ratio of 5.73. Of 125 (81.2%) ileostomies reversed, the median time‐to‐reversal was 11.99 months; time series analysis over the 7‐year period showed no significant trend for average patient‐days from booking to reversal (P = 0.60). Cox regression modelling did not identify any influential risk factors for the times taken to reversal. Conclusion This study supports the use of both contrast enema and flexible sigmoidoscopy in the assessment of rectal anastomosis integrity. Most patients with complications can have their ileostomies reversed. Patients who have adjuvant chemotherapy have a prolonged time to reversal.

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“…After removal of duplicates and screening by title and abstract, 25 full-text articles were assessed for eligibility. Of those, 11 retrospective [4,7,[10][11][12][13][14][15][16][17][18]] and 2 prospective studies [19,20] were included in the review. The 12 excluded articles [3,[21][22][23][24][25][26][27][28][29][30][31] and the reasons for their exclusion are listed in Table 3 [32] are provided as supplementary material (Supplementary Fig.…”

Section: Resultsmentioning

confidence: 99%

“…After removal of duplicates and screening by title and abstract, 25 full-text articles were assessed for eligibility. Of those, 11 retrospective [ 4 , 7 , 10 – 18 ] and 2 prospective studies [ 19 , 20 ] were included in the review. The 12 excluded articles [ 3 , 21 – 31 ] and the reasons for their exclusion are listed in Table 3 .…”

Section: Resultsmentioning

confidence: 99%

Less is more—the best test for anastomotic leaks in rectal cancer patients prior to ileostomy reversal

Lindner

Eitelbuss

Hetjens

et al. 2021

Int J Colorectal Dis

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Purpose No clear consensus exists on how to routinely assess the integrity of the colorectal anastomosis prior to ileostomy reversal. The objective of this study was to evaluate the accuracy of contrast enema, endoscopic procedures, and digital rectal examination in rectal cancer patients in this setting. Methods A systematic literature search was performed. Studies assessing at least one index test for which a 2 × 2 table was calculable were included. Hierarchical summary receiver operating characteristic curves were calculated and used for test comparison. Paired data were used where parameters could not be calculated. Methodological quality was assessed with the QUADAS-2 tool. Results Two prospective and 11 retrospective studies comprising 1903 patients were eligible for inclusion. Paired data analysis showed equal or better results for sensitivity and specificity of both endoscopic procedures and digital rectal examination compared to contrast enema. Subgroup analysis of contrast enema according to methodological quality revealed that studies with higher methodological quality reported poorer sensitivity for equal specificity and vice versa. No case was described where a contrast enema revealed an anastomotic leak that was overseen in digital rectal examination or endoscopic procedures. Conclusions Endoscopy and digital rectal examination appear to be the best diagnostic tests to assess the integrity of the colorectal anastomosis prior to ileostomy reversal. Accuracy measures of contrast enema are overestimated by studies with lower methodological quality. Synopsis of existing evidence and risk–benefit considerations justifies omission of contrast enema in favor of endoscopic and clinical assessment. Trial registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019107771

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The novel appearance of low rectal anastomosis on contrast enema following laparoscopic anterior resection: discriminating anastomotic leaks from “dog-ears” on water-soluble contrast enema and flexible sigmoidoscopy

Abstract: The novel appearances of laparoscopic-stapled rectal anastomoses in WSCE can be mistaken for anastomotic leak. To avoid delay in reversal of ileostomy, a flexible sigmoidoscopy can be used to confirm or exclude a leak.

Cited by 15 publications

References 12 publications

Short‐term outcomes of pelvic floor peritoneum closure in endoscopic low anterior resection of rectal cancer: A propensity score matching analysis

Short‐term outcomes of pelvic floor peritoneum closure in endoscopic low anterior resection of rectal cancer: A propensity score matching analysis

Investigations and time trends in loop ileostomy reversals following anterior resections: a single Australian institution seven‐years' experience

Less is more—the best test for anastomotic leaks in rectal cancer patients prior to ileostomy reversal

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