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Srinivas, L., B. Venkatesh und Samir Ahmad. „A study of factors leading to post-operative leaks following bowel anastomosis“. International Surgery Journal 5, Nr. 11 (26.10.2018): 3510. http://dx.doi.org/10.18203/2349-2902.isj20184218.
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Background: Intestinal anastomosis is one of the most commonly performed procedures, especially in the emergency setting and is also in the elective setting when resection is carried out for benign or malignant lesion of the gastrointestinal tract. Anastomotic leakage is a potentially disastrous complication, which can lead to sepsis and abdominal catastrophe. The aim of the study is to determine factors leading to post-operative leaks in gastrointestinal surgeries involving different kinds of anastomosis and to determine the role of parameters such as pre-operative hemoglobin, serum albumin, indication for surgery, degree of contamination, type of anastomosis, technical variations and postoperative management in anastomotic leaks. We also aim to determine the morbidity and mortality variation and to study the various presentations of anastomotic leak in the patient group as well.Methods: A prospective study was conducted from December 2015 till the end of august 2017 at Prathima Institute of Medical Sciences, Karimnagar. All patients undergoing gastrointestinal anastomosis electively and as an emergency procedure were included in this study. The total number of cases studied is 60.Results: Out of the 60 cases in this study, 49 cases were done electively, and 11 cases were done on an emergency basis. Anastomotic leaks occurred most in emergency cases (27.27%). Among 5 patients, (71.42%) leaks were managed conservatively and rest required intervention. There was increased death rate in patients with leak. Leaks occurred maximum in jejunoileal anastomosis. Most common organ involved was esophagus (28.57%).Conclusions: Anastomotic leaks are a common complication following all types of gastrointestinal anastomosis. It is believed, hypoalbuminemia hinders anastomotic healing. Surgeries indicated in emergency situation carried increased risk of operative leaks in post-operative period.
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Tan, Wei Phin, En Yaw Hong, Benjamin Phillips, Gerald A. Isenberg und Scott D. Goldstein. „Anastomotic Leaks after Colorectal Anastomosis Occurring More than 30 Days Postoperatively: A Single-institution Evaluation“. American Surgeon 80, Nr. 9 (September 2014): 868–72. http://dx.doi.org/10.1177/000313481408000919.
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National hospital registries only report colorectal anastomotic leaks (ALs) within 30 days post-operatively. The aim of our study was to determine the incidence and significance of ALs that occur beyond 30 days postoperatively. We performed a retrospective review of our prospective database from June 2008 to August 2012. A total of 504 patients were included. These patients were operated on by two surgeons. Any clinical or radiographic abnormalities were considered to be an anastomotic imperfection. A total of 504 patients were reviewed with a total of 18 (3.6%) anastomotic leaks. Six leaks (31.6% of leaks) were diagnosed more than 30 days postoperatively ( P < 0.001). Of the 18 leaks, interventional radiology drainage was performed for four cases and 14 patients required reoperation. All six delayed leaks required reoperation. There was one leak that occurred under 30 days, which was discovered on autopsy. The median follow-up was 12 months (range, 1 to 4 months). All the delayed leak patients presented with fistulas, whereas 58 per cent of typical leak patients presented with the triad of leukocytosis, fever, and abdominal pain. Colorectal anastomotic leaks can occur after the 30-day postoperative period. In patients with vague and atypical abdominal findings, anastomotic leak must be suspected. More systematic, prospective studies are required to help us further understand the risk factors and natural history of anastomotic failures in elective colorectal surgery.
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Lambert, Joel, Sanya Caratella, Eloise Lawrence und Bilal Alkhaffaf. „RA05.04: MANAGEMENT & OUTCOMES OF ANASTOMOTIC LEAKS FOLLOWING ESOPHAGECTOMY: A PROSPECTIVE 10-YEAR SINGLE-SITE EXPERIENCE“. Diseases of the Esophagus 31, Supplement_1 (01.09.2018): 28. http://dx.doi.org/10.1093/dote/doy089.ra05.04.
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Abstract Background Anastomotic leak after esophagectomy is associated with high levels of morbidity and may impact negatively on oncological outcomes. The aim of this single centre study was to describe our experience in managing these complications Methods From 2007–2017 data was reviewed retrospectively from our prospectively maintained electronic database. All patients underwent either 2 or 3 phase esophagectomy for cancer of the oesophagus or esophago-gastric junction. All histological sub-types and stage of cancer were included in the analysis. Anastomotic leaks were classified according to the Esophagectomy Complications Consensus Group (ECCG) guidelines; type I—conservative management, type II—non-surgical intervention, type III—surgical intervention. Results 224 esophagectomies were included in our analysis (104 (46%) minimally invasive, 120 (54%) open approach). The incidence of all anastomotic leaks was 10% (23/224). Surgical approach did not influence the incidence of anastomotic leak (minimally invasive 10 (43%), open approach 13(57%), P = 0.76). Five patients (22%) had a type I leak, 9 patients (39%) type II and 9 (39%) had a type III leak. There was an increase in the number of leaks managed non-surgically over the last 5 years compared to those in the first five years of our dataset (2012–2017: 11/23 (48%) vs 2007–2012: 4/23 (17%) P = 0.08). The median time for leak diagnosis was 8 days. Most leaks were diagnosed with oral contrast CT 19 (83%). Median hospital stay after anastomotic leak was 58.5 days. Type III leaks were associated with an increased length of stay (median 84 days) compared to type I&II leaks (median (38.5 days) (P = 0.002 95% CI 18.19- 74.41). There was no significant difference in 30-day mortality between type I&II (0 patients) and type III leaks (1 patient) P = 0.260. Conclusion Low mortality rates with anastomotic leak can be achieved. In centres with experienced radiological and endoscopic skills, most anastomotic leaks can be managed non-surgically. Disclosure All authors have declared no conflicts of interest.
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Cooper, Chad J., Angel Morales und Mohamed O. Othman. „Outcomes of the Use of Fully Covered Esophageal Self-Expandable Stent in the Management of Colorectal Anastomotic Strictures and Leaks“. Diagnostic and Therapeutic Endoscopy 2014 (18.12.2014): 1–6. http://dx.doi.org/10.1155/2014/187541.
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Introduction. Colorectal anastomotic leak or stricture is a dreaded complication leading to significant morbidity and mortality. The novel use of self-expandable metal stents (SEMS) in the management of postoperative colorectal anastomotic leaks or strictures can avoid surgical reintervention. Methods. Retrospective study with particular attention to the indications, operative or postoperative complications, and clinical outcomes of SEMS placement for patients with either a colorectal anastomotic stricture or leak. Results. Eight patients had SEMS (WallFlex stent) for the management of postoperative colorectal anastomotic leak or stricture. Five had a colorectal anastomotic stricture and 3 had a colorectal anastomotic leak. Complete resolution of the anastomotic stricture or leak was achieved in all patients. Three had recurrence of the anastomotic stricture on 3-month flexible sigmoidoscopy follow-up after the initial stent was removed. Two of these patients had a stricture that was technically too difficult to place another stent. Stent migration was noted in 2 patients, one at day 3 and the other at day 14 after stent placement that required a larger 23 mm stent to be placed. Conclusions. The use of SEMS in the management of colorectal anastomotic leaks or strictures is feasible and is associated with high technical and clinical success rate.
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Smith, Ellyn A., Shaun C. Daly, Brian Smith, Marcelo Hinojosa und Ninh T. Nguyen. „The Role of Endoscopic Stent in Management of Postesophagectomy Leaks“. American Surgeon 86, Nr. 10 (Oktober 2020): 1411–17. http://dx.doi.org/10.1177/0003134820964495.
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Introduction Anastomotic leak is a dreaded complication following esophagectomy. Conventional management for leaks includes invasive reoperation and even gastrointestinal diversion. Objective The aim of this study was to examine our contemporary outcome of using endoscopic esophageal stenting as primary therapy for management of anastomotic leak following minimally invasive esophagectomy (MIE). Methods We reviewed data on 11 patients who developed an esophageal leak following 111 MIE between January 2011 and December 2019. Of the 11 anastomotic leaks, 10 patients had an anastomotic disruption and underwent endoscopic esophageal stenting as primary therapy for management of leaks, while 1 patient had an anastomotic disruption complicated by an associated tracheoesophageal fistula that required surgical reoperation and subsequent colonic interposition. Main outcome measures focused on the 10 patients who were managed with endoscopic stenting, including length of hospital stay following leak management, need for thoracotomy or gastrointestinal diversion for leak, stent complications, and leak-associated mortality. Results Of the 10 patients who underwent endoscopic esophageal stenting as primary therapy for management of leaks, there were 8 males with a median age of 66 years. The median time to diagnosis of anastomotic leak was 10 days postoperatively. One of the ten patients also underwent percutaneous drain placement, while none of the patients required thoracotomy. Median duration of stent placement was 39 (range, 29-105) days. Median length of stay after stent placement was 10 (range, 4-43) days. The median number of stent exchange was 1 (range, 1-3) stent. Gastrointestinal continuity was maintained in all patients. The 90-day leak-associated mortality was 9.1% (1 of 11 patients). Conclusions Endoscopic stenting is an effective primary therapy in the management of postesophagectomy leak and avoids the need for an invasive, reoperative thoracotomy or gastrointestinal diversion procedure.
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Peracchia, Alberto, Romeo Bardini, Alberto Ruol, Massimo Asolati und Domenico Scibetta. „Esophagovisceral anastomotic leak“. Journal of Thoracic and Cardiovascular Surgery 95, Nr. 4 (April 1988): 685–91. http://dx.doi.org/10.1016/s0022-5223(19)35737-x.
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Řezáč, Tomáš, Martin Stašek, Pavel Zbořil und Petr Špička. „The role of CRP in the diagnosis of postoperative complications in rectal surgery“. Polish Journal of Surgery 93, Nr. 5 (22.04.2021): 1–5. http://dx.doi.org/10.5604/01.3001.0014.6591.
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Introduction: Postoperative anastomotic leak after rectal resection is a life-threatening complication. Late diagnosis and a severe symptomatic leak may cause almost 18 % mortality. Early diagnosis is a challenging issue because of nonspecific clinical signs in the early postoperative period. Minimally invasive rectal surgery and the implementation of ERAS protocol require appropriate markers of inflammatory complications and leak with high sensitivity. Postoperative serum C-reactive protein values seem to be the right answer for this question. Aim: The presented study aimed to determine the importance and cut-off level of serum C-reactive protein as a possible predictive factor for early anastomotic leak diagnosis in rectal surgery. Material and methods: The retrospective observational analysis of patients after resection for rectal cancer in a period of one year. The observation included risk factors (age, sex, BMI, bowel preparation and the acuteness of surgery), recording of complications and serum values of CRP. Results: The study included 178 patients. 63 patients (35,4 %) had non-complicated postoperative course. The complications were present in 115 cases (64,6 %), including surgical site infection (16,3 %) and anastomotic leak (7,3 %). The mortality was 2,2 %. CRP serum value reached the sensitivity 94,7 % and specificity 72,5 % at POD 4 with cut off value of 131,8 mg/l and the sensitivity of 84,2 % and specificity 82,4 % with cut off 175,4 mg/l, respectively. Conclusions: Postoperative serum C-reactive protein may be used as a predictor of anastomotic leakage. The examination of CRP on the 4th postoperative day may lead to early and safe discharge from the hospital after rectal resection. The implementation of the cut off values detects more than 90 % of anastomotic leaks or septic complications.
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D’Souza, N., PD Robinson, G. Branagan und H. Chave. „Enhanced recovery after anterior resection: earlier leak diagnosis and low mortality in a case series“. Annals of The Royal College of Surgeons of England 101, Nr. 7 (September 2019): 495–500. http://dx.doi.org/10.1308/rcsann.2019.0067.
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Introduction Early detection and treatment of anastomotic leak may mitigate its consequences. Within an enhanced recovery setting, the subtle signs of a leak can be more apparent. There are multiple treatment options for anastomotic leak following anterior resection. This study aimed to determine when leaks are diagnosed in enhanced recovery, and whether the choice of intervention affects outcomes. Materials and methods We conducted a retrospective study of a prospectively maintained database of complications of anterior resections for rectal cancer in a district general hospital in the UK. Data were extracted on day of leak diagnosis, length of stay, intensive care admission, mortality and ileostomy reversal rate. Statistical analysis was performed using Student’s t, Mann–Whitney U and chi square tests. Results A total of 323 patients underwent anterior resection for colorectal cancer between 1 January 2007 and 1 October 2015. The leak rate was 10.8% (35/323). Patients were diagnosed in hospital with leaks on median day 4 compared with day 11 for patients diagnosed with leaks after readmission from home (P < 0.001). Defunctioned patients diagnosed with a leak had a longer median length of stay (24 vs 18.0 days, P = 0.31) but were more frequently managed non-operatively (100% vs 19.0%, P < 0.001) and had a lower admission rate to intensive care (9.5% vs 42.9%, P = 0.02) than patients who were not defunctioned at time of resection. Overall mortality from anastomotic leak was 2.9% (1/35). Ileostomies were reversed in 73.5% of patients (25/34). Discussion Enhanced recovery enables early diagnosis of leaks following anterior resection. Defunctioning of patients with anastomotic leak lowers mortality.
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Hallit, Rachel, Mélanie Calmels, Ulriikka Chaput, Diane Lorenzo, Aymeric Becq, Marine Camus, Xavier Dray et al. „Endoscopic management of anastomotic leak after esophageal or gastric resection for malignancy: a multicenter experience“. Therapeutic Advances in Gastroenterology 14 (Januar 2021): 175628482110328. http://dx.doi.org/10.1177/17562848211032823.
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Background: Most anastomotic leaks after surgical resection for esophageal or esophagogastric junction malignancies are treated endoscopically with esophageal stents. Internal drainage by double pigtail stents has been used for the endoscopic management of leaks following bariatric surgery, and recently introduced for anastomotic leaks after resections for malignancies. Our aim was to assess the overall efficacy of the endoscopic treatment for anastomotic leaks after esophageal or gastric resection for malignancies. Methods: We conducted a multicenter retrospective study in four digestive endoscopy tertiary referral centers in France. We included consecutive patients managed endoscopically for anastomotic leak following esophagectomy or gastrectomy for malignancies between January 2016 and December 2018. The primary outcome was the efficacy of the endoscopic management on leak closure. Results: Sixty-eight patients were included, among which 46 men and 22 women, with a mean ± SD age of 61 ± 11 years. Forty-four percent had an Ivor Lewis procedure, 16% a tri-incisional esophagectomy, and 40% a total gastrectomy. The median time between surgery and the diagnosis of leak was 9 (6–13) days. Endoscopic treatment was successful in 90% of the patients. The efficacy of internal drainage and esophageal stents was 95% and 77%, respectively ( p = 0.06). The mortality rate was 3%. The only predictive factor of successful endoscopic treatment was the initial use of internal drainage ( p = 0.002). Conclusion: Endoscopic management of early postoperative leak is successful in 90% of patients, preventing highly morbid surgical revisions. Internal endoscopic drainage should be considered as the first-line endoscopic treatment of anastomotic fistulas whenever technically feasible.
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Mitchell, John D. „Anastomotic Leak After Esophagectomy“. Thoracic Surgery Clinics 16, Nr. 1 (Februar 2006): 1–9. http://dx.doi.org/10.1016/j.thorsurg.2006.01.011.
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Heisler, Kenneth A. „Treatment of Anastomotic Leak“. Journal of the American College of Surgeons 219, Nr. 3 (September 2014): 592. http://dx.doi.org/10.1016/j.jamcollsurg.2014.06.004.
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Jaju, Pradeep, Tejaswini Vallabha, Girish Kulloli und Vikram Sindagikar. „Can analysis of drain fluid biomarkers predict anastomotic leak?“ International Surgery Journal 8, Nr. 5 (28.04.2021): 1481. http://dx.doi.org/10.18203/2349-2902.isj20211812.
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Background: Anastomotic leak is a major complication often leading to significant morbidity and mortality. A method to predict leaks in the early postoperative period will help in better management and outcome. Though serum biomarkers like C-reactive protein and procalcitonin levels are often used to predict chances of developing complications, they are nonspecific and suggest mainly ongoing sepsis in general. Detection and assessment of the presence of these biomarkers at the local milieu is an alternate non-invasive option as they are produced at the injury site and increase in anastomotic leaks. If measured serially, can guide to a strong suspicion of a leak before the clinical signs are evident. Methods: Forty-eight patients who underwent intestinal anastomosis for various indications were included. Serial measurement of drain fluid C-reactive protein and procalcitonin were measured on postoperative days 3, 5 and 7.Results: 7 patients developed leaks with two deaths. CRP and procalcitonin levels were higher on all days in comparison with the no leak group. CRP had the highest sensitivity on day 5 with 85.71% and 97.56% specificity on day7. The sensitivity and specificity of procalcitonin were 71.43% and 97.56% on day 5 and day 7. Accuracy was 93.7% for CRP and 87.5% for procalcitonin on the seventh day.Conclusions: Serial analysis of drain fluid CRP and procalcitonin showed persistently increased levels in patients with an anastomotic leak. Correlation of the levels in patients with anastomotic leak suggests the possibility of their utility in the early detection of leaks.
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Klymenko, Andrii, und Igor Kononenko. „PREVENTION OF COLORECTAL ANASTOMOTIC LEAK“. Kharkiv Surgical School, Nr. 5-6 (25.12.2019): 21–25. http://dx.doi.org/10.37699/2308-7005.5-6.2019.04.
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Summary. Colorectal anastomotic leak after low anterior resection of sigmoid colon and rectum is one of the hardest complications leading to perioperative morbidity and mortality increase and prolonged hospital stay. One of the directions of contemporary research includes assessment and improval of anastomotic technique as well with the use of staplers to decrease the risk of anastomotic leak and rate of uncomfortable protective ileostomy. There is no consensus today about this matter.
In our research we dealt with the results of 92 patients after laparoscopic anterior resection for rectal cancer. The main group consisted of 32 (32.9%) patients who had undergone laparoscopic anterior resection for rectal cancer with the use of modified in our clinic anastomotic technique and intraoperative videoscopic assessment of the colorectal anastomosis. The control group consisted of 60 (65.2%) patients after standard traditional laparotomy for rectal cancer. 7.6% of the patients in total had specific related to the surgical techniques complications at the intra and postoperative period with no statistic difference between the groups. The modified in the clinic anastomotic technique which includes oversawing of the stapler line with seroserous stitches and anastomose assessment by simple laparoscope videorectoscopy proved to be useful and prevented leak in all the patients.
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Tannuri, Uenis, Ana Cristina Aoun Tannuri, Marina Fussae Fukutaki, Maura Salaroli de Oliveira, Valéria Marques Figueira Muoio und Alfonso Araujo Massaguer. „Effects of circular myotomy on the healing of esophageal suture anastomosis: an experimental study“. Revista do Hospital das Clínicas 54, Nr. 1 (Februar 1999): 09–16. http://dx.doi.org/10.1590/s0041-87811999000100003.
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For esophageal reconstruction in newborns with esophageal atresia, esophageal reunion with an end-to-end anastomosis is the ideal procedure, although it may result in leaks and strictures due to tension on the suture line, mainly in cases with a wide gap between the ends. Circular myotomy (Livaditis' procedure) is the best method to elongate the proximal esophageal pouch and reduce anastomotic tension. This experimental investigation in dogs was undertaken to attempt to verify that circular myotomy decreases the anastomotic leak rate in newborns with wide gap esophageal atresia, and to analyze whether the technique promotes morphologic changes in the anastomotic scar. A pilot study demonstrated that it is necessary to resect more than 8 cm (40% of the total esophageal length) in order to obtain high leak rates. In the experimental project, such resection was performed in dogs divided into two groups (control group, anastomosis only, and experimental group, anastomosis plus circular myotomy in the proximal esophageal segment). The animals were killed in the 14th postoperative day, submitted to autopsy, and were evaluated as to the presence of leaks and strictures, as well as to the features (macroscopic and microscopic aspects) of the anastomosis. Leak rates were the same in both groups. Morphometric analysis revealed that in animals in the experimental group, the anastomotic scar was thinner than the control animals, and the isolated muscular manchette distal to the site of myotomy was replaced by fibrous tissue. Correspondingly, a decreased number of newly formed small vessels were noted in the experimental animals, compared to control animals. We concluded that circular myotomy does not decrease the incidence of anastomotic leaks, and it also promotes deleterious changes in anastomotic healing.
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Mujalde, Vikram Singh, Dinesh Kumar Barolia, Pradeep Gupta, Sunil Mehra und Arun Gupta. „A prospective study in esophageal atresia with tracheoesophageal fistula: Oblique versus circular anastomosis“. International Surgery Journal 5, Nr. 5 (21.04.2018): 1894. http://dx.doi.org/10.18203/2349-2902.isj20181605.
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Background: Congenital esophageal atresia with tracheo-esophageal fistula is a common congenital anomaly facing at our centre. There is various proposed anastomotic technique to avoid post-op stricture. In this study we compare outcome of oblique and circular anastomosis technique at our centre.Methods: This study conducted in 60 cases of congenital esophageal atresia with tracheo-esophageal fistula, designed randomly in two groups. Oblique anastomosis in group A and Circular anastomosis in group B. The complications of anastomotic leaks, anastomotic narrowing with strictures and recurrent fistula were studied.Results: Anastomotic leak rate in case oblique anastomosis was 6.7% as compared to circular anastomosis was 16.7%. Stricture formation in oblique anastomosis was 13.3% in comparison to circular anastomosis there was 43.3% stricture formation. None of the cases required re-exploration in Oblique anastomosis, whereas two (6.7%) cases required re-exploration in circular anastomosis.Conclusions: Present study showed that oblique anastomotic technique is superior to circular anastomotic technique, in term of less stricture and leak rate.
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Shanker, Vishnu, Roop Kishan Kaul und Abhishek Singh Rathore. „Factors affecting the outcome of intestinal anastomosis: a prospective study“. International Surgery Journal 8, Nr. 5 (28.04.2021): 1433. http://dx.doi.org/10.18203/2349-2902.isj20211423.
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Background: Anastomotic leak is one of the most dreaded complications after intestinal anastomosis. The prevalence of anastomotic leak is 0.5%-30% in literature and resulting mortality rate is 10%-15%. Various risk factors are known to be associated with it. This study was undertaken with the aim to identify and evaluate these predisposing factors.Methods: A prospective study was conducted from March 2019 to February 2020 at Teerthankar Mahaveer medical college and research centre, Moradabad. All patients undergoing hand-sewn gastro-intestinal anastomosis electively as well as in emergency were included in this study. The total number of cases studied were 80.Results: Post-operative anastomotic leaks were present in 10% and associated mortality was 100%. Increasing age was associated with leakage (p=0.02) and 75% patients with leaks were male. The following were observed to be significant risk factors associated with anastomotic dehiscence: diabetes mellitus (p=0.05), pallor (p=0.01), low haemoglobin (p=0.003), altered TLC count (p=0.008) low serum protein (p=0.001), albumin (p=0.001) longer operative time (p=0.02). Other predisposing factors like serum creatinine, hyperbilirubinema, elective/emergency surgeries, contamination of peritoneal cavity and time taken to perform the anastomosis were insignificant statistically.Conclusions: This study identified and assessed the various risk factors associated with anastomotic leaks and found age, sex, anaemia, sepsis, hypoproteinemia, hypoalbuminemia, increased operative-time to be significant and we concluded that controlling these factors will help in minimizing the chances of anastomotic dehiscence.
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Lecster, B., I. Asztalos und C. Polnyib. „Septic complication after low anterior rectal resection: Is diverting stoma still justified?“ Acta chirurgica Iugoslavica 49, Nr. 2 (2002): 67–71. http://dx.doi.org/10.2298/aci0202067l.
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A retrospective study was designed to determine the effects of faecal diversion on the rate and severity of clinical anastomotic leaks after low anterior resection. The study explored the complications of stoma closure as well. During the period between 1 January 1995 and 30 July 2000, anterior rectal resection was performed on 249 patients with anastomoses created at a 6-cm or smaller distance to the dentate line. In 74 cases, the anastomosis was protected by loop ileostomy. The indications for creating a stoma were evaluated subjectively, by the operating surgeon. In 64 patients, the ileostoma was closed 3 months later. A "clinical leak" after anterior resection was defined as an anastomotic insufficiency with clinically relevant consequences. The overall rate of anastomotic leak was 6.4 per cent; it was 5.1% (9/175) without and 9.4% (7/74) with a protective stoma. In 8 out of 9 patients, the anastomotic leak that had occurred without a protective stoma warranted laparatomy and defunctioning colostomy. Lavage and drainage of the peritoneal cavity and the pre-sacral space were necessary in 6 out of these 8 cases - and furthermore, the deranged anastomosis had to be removed in 2 patients. Local management was successful in a single case only. Although relaparotomy entails long-term intensive care, all reoperated patients survived anastomotic leakage. Seven patients with a leak despite a protective did not require laparatomy; transanal drainage was appropriate in all cases. There were no fatalities in this group either. Only one fatal complication from suture leakage occurred after stoma-closure. Abdominal exploration was inevitable in almost all patients with a clinical anastomotic leak and without defunctioning stoma. By contrast, patients with anastomotic insufficiency despite a protective stoma were successfully managed without further intra-abdominal intervention. As shown by these results, faecal diversion undoubtedly mitigates the clinical consequences of anastomotic leaks, but cannot prevent its occurrence. When considering the cumulative risk of surgical complications associated with anterior resection, the complications of stoma-closure must also be taken into account. Our data confirm that a defunctioning stoma is beneficial for high-risk patients, who are unfit for a second abdominal procedure required to control suture leakage.
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Kent, Ilan, Cyrus Jahansouz, Amandeep Ghuman, Baruch Shpitz, Debora Kidron, Victoria Yaffe, Imad Abu El-Naaj et al. „Human Oral Mucosal Stem Cells Reduce Anastomotic Leak in an Animal Model of Colonic Surgery“. European Surgical Research 62, Nr. 1 (2021): 32–39. http://dx.doi.org/10.1159/000514987.
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<b><i>Background:</i></b> Anastomotic leak is regarded as one of the most feared complications of bowel surgery; avoiding leaks is a major priority. Attempts to reduce or eliminate leaks have included alternate anastomotic techniques. Human oral mucosa stem cells (hOMSC) are self-renewing and expandable cells derived from buccal mucosa. Studies have shown that hOMSC can accelerate tissue regeneration and wound healing. The objective of this study was to evaluate whether hOMSC can decrease anastomotic leak rates in a murine model of colon surgery. <b><i>Methods:</i></b> Two experiments were performed. In the first study, mice underwent colonic anastomosis using five interrupted sutures. hOMSC (<i>n</i> = 7) or normal saline (NS; <i>n</i> = 17) was injected into the colon wall at the site of the anastomosis. To evaluate whether hOMSC can impact anastomotic healing, the model was stressed by repeating the first experiment, reducing the number of sutures used for the construction of the anastomosis from five to four. Either hOMSC (<i>n</i> = 8) or NS (<i>n</i> = 20) was injected at the anastomosis. All mice that survived were sacrificed on postoperative day 7. Anastomotic leak rate, mortality, daily weight, and daily wellness scores were compared. <b><i>Results:</i></b> In the five-suture anastomosis, there were no differences in anastomotic leak rate, mortality, or daily weight. Mice that received hOMSC had significantly higher wellness scores on postoperative day 2 (<i>p</i> < 0.05). In the four-suture anastomosis, there was a significant decrease in leak rate (70% [NS] vs. 25% [hOMSC], <i>p</i> = 0.029) and higher wellness scores in mice that received hOMSC (<i>p</i> < 0.05). <b><i>Conclusion:</i></b> Our study suggests that injecting hOMSC at the colonic anastomosis can potentially reduce anastomotic leak and improve postoperative wellness in a murine model of colon surgery.
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Kanatas, A. N., A. Aldouri und J. D. Hayden. „Anastomotic leak after oesophagectomy and stent implantation: a systematic review“. Oncology Reviews 4, Nr. 3 (05.12.2011): 159. http://dx.doi.org/10.4081/oncol.2010.159.
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Anastomotic leaks following oesophageal cancer resection have a high mortality. Stents have an established position in the palliation of dysphagia due to malignancy and in treating malignant perforation or fistula. They are increasingly used for benign conditions such as spontaneous oesophageal perforation with encouraging results. In this systematic review we examine the available evidence and attempt to define the role of stents in the management of oesophageal anastomotic leaks after resection for cancer. It is evident from the review that plastic- and metal-covered stents are an effective strategy for the treatment of anastomotic leaks. Vigilance is required as complications such as stent migration and incomplete sealing are not uncommon. Further clinical studies with greater methodological rigor in terms of sample size and study design may confirm that stents have an important contribution to make in the management of oesophageal anastomotic leak.
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Roy-Choudhury, Shuvro H., Anthony A. Nicholson, Kevin R. Wedgwood, Richard A. J. Mannion, Peter C. Sedman, Christopher M. S. Royston und David J. Breen. „Symptomatic Malignant Gastroesophageal Anastomotic Leak“. American Journal of Roentgenology 176, Nr. 1 (Januar 2001): 161–65. http://dx.doi.org/10.2214/ajr.176.1.1760161.
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Thomas, Michael, und David Margolin. „Management of Colorectal Anastomotic Leak“. Clinics in Colon and Rectal Surgery 29, Nr. 02 (26.05.2016): 138–44. http://dx.doi.org/10.1055/s-0036-1580630.
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Deshmane, V. H., und S. R. Shinde. „The cervical esophagogastric anastomotic leak“. Diseases of the Esophagus 7, Nr. 1 (01.01.1994): 42–45. http://dx.doi.org/10.1093/dote/7.1.42.
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Brown, Jessica L., und John M. Grosel. „Anastomotic leak after bowel resection“. Journal of the American Academy of Physician Assistants 26, Nr. 8 (August 2013): 1. http://dx.doi.org/10.1097/01.jaa.0000432581.05549.ae.
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Tutone, Senitila, und Andrew G. Hill. „Anastomotic Leak After Colonic Resection“. Diseases of the Colon & Rectum 62, Nr. 1 (Januar 2019): 9–11. http://dx.doi.org/10.1097/dcr.0000000000001269.
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Lee, Jennifer K., und Nitin Mishra. „Predicting anastomotic leak: Can we?“ Seminars in Colon and Rectal Surgery 25, Nr. 2 (Juni 2014): 74–78. http://dx.doi.org/10.1053/j.scrs.2014.04.003.
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Smith, Ross C. „Pancreaticoenteric anastomotic leak following pancreaticoduodenectomy“. ANZ Journal of Surgery 71, Nr. 9 (September 2001): 505–6. http://dx.doi.org/10.1046/j.1440-1622.2001.02179.x.
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Vieira, Felipe, Ricardo Schramm, Marcio Chedid, André Ricardo Da Rosa und Cleber Dario Kruel. „PS02.111: A 5-YEAR EXPERIENCE IN ANASTOMOTIC LEAK AFTER NEODJUVANT FOLLOWED ESOPHAGECTOMY IN A BRAZILIAN UNIVERSITY HOSPITAL“. Diseases of the Esophagus 31, Supplement_1 (01.09.2018): 152. http://dx.doi.org/10.1093/dote/doy089.ps02.111.
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Abstract Background Neoadjuvant treatment of esophageal cancer is world accepted since 2012 (1), showing benefits in long-term survival. However, there is still controversy relating to potential complications with the use of antineoplastic drugs and radiotherapy, notably because of the higher incidence of cervical esophageal leak. Our study describes a five-year experience in anastomotic leaks in esophagectomies after neoadjuvant therapy in a southern Brazilian referral center. Methods We have analyzed all patients submitted to the combined treatment of neoadjuvant therapy plus esophagectomy between 2012–2016, including patients with squamous cell carcinoma and adenocarcinoma. We describe the number of patients that experienced anastomotic leak after surgery. The diagnosis of an anastomotic leak is based in any quantity of digestive secretion in the neck wound, seen on the post-operative period. It did not secrete bacteriological analysis. McKeown and transhiatal esophagectomy were used, and esophagogastric anastomosis were conducted in the cervical region. Results Between the years of 2012–2016, thirty-six patients were submitted to a combined treatment of neoadjuvant therapy plus esophagectomy. Of these patients, 20 (55%) evolved with anastomotic leaks. All of these leaks occurred in the cervical region, and were treated in a conservative way. Conclusion The incidence of anastomotic leaks was exceptionally high, regardless of the usual care. Possible causes of this high number of leaks could be related to diagnostic criterion, the patient's own characteristics, local alterations associated to the neoadjuvant treatment, the surgical technique, or even microbiological factors. New studies are necessary with the goal to determine which of these factors contributes in the most significant way, with the means to improve the results of this unpleasant esofagectomy complication. 1) VAN HAGEN, P. et al. Preoperative Chemoradiotherapy for Esophageal or Junctional Cancer. New England Journal Of Medicine,[s.l.], v. 366, n. 22, p.2074–2084, 31 maio 2012. New England Journal of Medicine (NEJM/MMS). http://dx.doi.org/10.1056/nejmoa1112088. Disclosure All authors have declared no conflicts of interest.
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Nagib, Anthony, Chauniqua Kiffin, Eddy H. Carrillo, Andrew A. Rosenthal, Rachele J. Solomon und Dafney L. Davare. „Necrotizing Fasciitis Resulting from an Anastomotic Leak after Colorectal Resection“. Case Reports in Surgery 2018 (16.09.2018): 1–3. http://dx.doi.org/10.1155/2018/8470471.
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One of the most feared complications in colorectal surgery is an anastomotic leak (AL) following a colorectal resection. While various recommendations have been proposed to prevent this potentially fatal complication, anastomotic leaks still occur. We present a case of an AL resulting in a complicated and fatal outcome. This case demonstrates the importance of high clinical suspicion, early recognition, and immediate management.
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Ivanov, Dejan, Radovan Cvijanovic und Ljiljana Gvozdenovic. „Intraoperative air testing of colorectal anastomoses“. Srpski arhiv za celokupno lekarstvo 139, Nr. 5-6 (2011): 333–38. http://dx.doi.org/10.2298/sarh1106333i.
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Introduction. Intraoperative anastomotic air testing of stapled colorectal anastomosis is performed by filling the pelvis with saline solution and insufflating the rectum with air through a sigmoidoscope. The presence of air bubbles indicates anastomotic leaks which are resolved during surgery. Objective. The aim of this prospective, randomized study was to perform a comparative analysis regarding the number of anastomotic dehiscences in patients checked by air leak testing and in the control group without air testing. Methods. After stapled colorectal anastomosis was performed, patients were randomized into two groups of 30 patients. The first group patients underwent intraoperative anastomotic air testing, whereas in the control group this procedure was not performed. The two groups were matched for age, sex, diagnosis and surgical procedure. Results. Intraoperative air tests were positive in seven cases and anastomotic defects were repaired. After surgery, there were three clinical leaks in this group of patients. In the control group, there were six leaks (Unilateral Fischer?s exact test, p=0.24). The incidence of colorectal anastomotic dehiscences in the study group was lower than in the control group by 50%. However, this finding was not statistically significant in our sample. Conclusion. In our opinion, intraoperative air testing of colorectal anastomosis is a good method for prevention of anastomotic dehiscence.
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ASKARPOUR, Shahnam, Mehran PEYVASTEH, Hazhir JAVAHERIZADEH und Nasim ASKARI. „EVALUATION OF RISK FACTORS AFFECTING ANASTOMOTIC LEAKAGE AFTER REPAIR OF ESOPHAGEAL ATRESIA“. ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) 28, Nr. 3 (September 2015): 161–62. http://dx.doi.org/10.1590/s0102-67202015000300003.
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Background: Anastomotic leak are reported among neonates who underwent esophageal atresia. Aim: To find risk factors of anastomotic leakage in patients underwent esophageal repair. Methods: All cases with esophageal atresia were included. In this case control study, patients were classified in two groups according to presence or absence of anastomotic leaks. Duration of study was 10 years. Results: Sixty-one cases were included. Mean±SD age at time of surgery in patients with leakage and without leakage was 9.50±7.25 and 8.83±6.93 respectively (p=.670). Blood transfusion and two layer anastomosis had significant correlation with anastomotic leakage. Conclusion: Blood transfusion and double layer anastomosis are associated with higher rate of anastomotic leakage.
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Bohle, Wolfram, Ioannis Louris, Andre Schaudt, Joerg Koeninger und Wolfram G. Zoller. „Predictors for Treatment Failure of Self-Expandable Metal Stents for Anastomotic Leak after Gastro-Esophageal Resection“. Journal of Gastrointestinal and Liver Diseases 29, Nr. 2 (03.06.2020): 145–49. http://dx.doi.org/10.15403/jgld-463.
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Background and Aims: Self-expandable metal stents are used for the treatment of anastomotic leaks after gastro- esophageal surgery. Predictors for treatment failure and complications are unknown. In this observational retrospective study, we summarize our experience with self-expandable metal stents for the treatment of anastomotic leaks, in order to determine the predictors of treatment failure.
Methods: Between 2009 and 2015, 34 patients with anastomotic leak after curative resection of gastro- esophageal cancer were treated with self-expandable metal stents. Gender, histology, comorbidity, body mass index, neoadjuvant therapy, previous surgery, leak size, and stent diameter were analyzed for their predictive value according to treatment success and complication rate.
Results: Leak closure rate was 76%. Risk factors for treatment failure were neoadjuvant chemo-radiotherapy, squamous cell histology, and esophageal tumor location. Gender, comorbidity, body mass index, neoadjuvant chemotherapy, and previous surgery were not correlated with outcome. Mortality rate was 20%, most often due to uncontrolled leak. Severe stent-related complications occurred in 15% of patients, most of them following insertion of a large-sized stent.
Conclusion: Squamous cell histology, neoadjuvant chemo-radiotherapy, and esophageal tumor location are predictors for treatment failure. Severe stent-related complications seem to be preferentially associated with the use of large-sized stents.
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Wang, Lily, Steven Milman und Thomas Ng. „Performance of the transoral circular stapler for oesophagogastrectomy after induction therapy“. Interactive CardioVascular and Thoracic Surgery 29, Nr. 6 (22.08.2019): 890–96. http://dx.doi.org/10.1093/icvts/ivz203.
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Abstract OBJECTIVES Patients undergoing oesophageal anastomosis may be at an increased risk for leak after induction therapy for oesophageal cancer, with intrathoracic leaks having significant morbidity. The outcomes of utilizing transoral circular stapler for the creation of a thoracic anastomosis have not been well studied in this patient population. METHODS Patients with oesophageal cancer undergoing induction chemotherapy/radiation followed by Ivor Lewis oesophagogastrectomy were evaluated. All thoracic anastomoses were constructed with transoral circular stapler. Primary outcomes evaluated were the rates of anastomotic leak and stricture. RESULTS Over 7 years, 87 consecutive patients were evaluated, among whom 69 (79%) were male. The median age was 63 years, median body mass index (BMI) was 27 kg/m2 and median age-adjusted comorbidity index was 5. Median operative blood loss was 400 ml and median operative time was 300 min. Major complications (grade ≥3) were seen in 19 (22%), including anastomotic leak in 2 (2.3%), both successfully treated with temporary covered metal stent. The median duration of hospital stay was 10 days, and 1 (1.2%) death was reported at 90 days due to cancer recurrence. Stricture occurred in 8 (9.2%), and median time to dilation was 109 days and median number of dilations was 1. Univariable analysis found BMI to be significantly higher in patients with an anastomotic leak versus those without (43 vs 27 kg/m2, P = 0.002). No variables were found to be predictive of anastomotic stricture. CONCLUSIONS The use of the transoral circular stapler for thoracic anastomosis results in a consistent formation of the anastomosis, with low leak and stricture rates in the setting of induction chemotherapy/radiation. Leaks that do occur appear to be amenable to stent therapy.
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Pawar, Tejaswini Murari, Ravikiran Hosur Ramamurthy und Shashirekha Chikkavenkataswamy Anjaneyulu. „Single Layer Versus Double Layer Anastomosis of Small Intestine – A Comparative Study from Karnataka, India“. Journal of Evolution of Medical and Dental Sciences 10, Nr. 30 (26.07.2021): 2300–2304. http://dx.doi.org/10.14260/jemds/2021/470.
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BACKGROUND Intestinal anastomosis is an operative procedure that is of importance in the practice of surgery. It is a very commonly performed technique in today’s surgical era. We wanted to study the postoperative complications like anastomotic leak and abscess formation and duration of hospital stay in single layer and double layer anastomosis and compare the same. METHODS In our prospective observational study, 80 patients were reviewed and were divided into 2 groups. Cases were allotted to either group based on the odd even method requiring single- and double-layer anastomosis, odd being single layer and even being double layer anastomosis. Intestinal anastomosis was carried out in single layer technique with delayed absorbable suture material and double layer technique with inner transmural layer with delayed absorbable suture material and seromuscular layer with non-absorbable suture material. RESULTS Each group had 40 patients, there was significant difference noted between the groups. Mean duration of hospital stay in single layer group was 17.85 ± 7.62 days and in double layer group was 26.20 ± 16.12 days (P = 0.043 *). In single group, mean time taken for anastomosis was 18.50 ± 1.73 and in double group was 29.05 ± 2.19. There was significant difference in time taken between two groups (P < 0.001). In single group, majority of subjects had no anastomotic Leak (95 %) and 5 % had leak. In double group 70 % had no leak and 30 % had leak. P value was statistically significant (P = 0.037). CONCLUSIONS Single layer anastomosis was better in terms of duration of hospital stay, postoperative anastomotic leaks and time taken for anastomosis. KEY WORDS Single Layer, Double Layer, Small Bowel, Duration of Hospital Stay, Anastomotic Leaks
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LODHI, FAISAL BILAL, M. SHAFIQ, TARIQ FAROOQ und Riaz Hussain. „ANASTOMOTIC LEAK AFTER SMALL GUT SURGERY“. Professional Medical Journal 13, Nr. 01 (06.03.2006): 47–50. http://dx.doi.org/10.29309/tpmj/2006.13.01.5056.
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Background: Anastomotic leak after gastrointestinal surgery is animportant postoperative event that leads to significant morbidity and mortality. Postoperative leak rates are frequentlyused as an indicator of the quality of surgical care provided. Objective:(1).To define factors associated with leakageof small gut anastomosis. (2) To find technique of small gut anastomosis associated with lowest risk of anastomoticdehiscence. Study Design: Retrospective, Descriptive Duration: 02 Years (May 2003 to May 2005) Material andMethods: This study was conducted at Surgical Unit-II, Allied Hospital, Punjab Medical College, Faisalabad from Dec2003 to May 2005. A total number of 36 cases were included in this study comprising of both adult male and femalepatients developing anastomotic dehiscence following resection and end to end anastomosis of small gut. Results:Peritonitis was the risk factor identified in 69% of the patients. Hypovolemic shock both preoperatively and in theimmediate postoperative period was noted in 56% cases while 83% of the patients with anastomotic dehiscence hadhaemoglobin concentration less than 10g%. High concentration of blood urea was noted in 42% of the cases. It turnedto normal as soon as the hypovolemia was corrected in these cases. Small gut anastomosis done in emergency setting(75% cases) was associated with increased risk of anastomotic dehiscence as compared to the dehiscence noted in09 cases (25%) operated on elective list. Three different techniques were used for small gut anastomosis. The rate ofanastomotic leakage ranged from 19-45%. Conclusion: Peritonitis, hypovolaemia and low hemoglobin alone or incombination are associated with increased risk of small gut anastomotic leakage especially after emergency surgery.Single layered extramucosal interrupted anastomosis was associated with less risk of dehiscence than the full thicknessand continuous extramucosal anastomosis.
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Kodner, Ira J. „Stapled anastomotic leaks“. Journal of the American College of Surgeons 185, Nr. 2 (August 1997): 185–86. http://dx.doi.org/10.1016/s1072-7515(01)00902-4.
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Arezzo, A., M. Migliore, P. Chiaro, S. Arolfo, C. Filippini, D. Di Cuonzo, R. Cirocchi und M. Morino. „The REAL (REctal Anastomotic Leak) score for prediction of anastomotic leak after rectal cancer surgery“. Techniques in Coloproctology 23, Nr. 7 (25.06.2019): 649–63. http://dx.doi.org/10.1007/s10151-019-02028-4.
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Arezzo, A., C. Filippini und M. Morino. „The REAL (REctal Anastomotic Leak) score for prediction of anastomotic leak after rectal cancer surgery“. Techniques in Coloproctology 25, Nr. 2 (15.01.2021): 247–48. http://dx.doi.org/10.1007/s10151-021-02409-8.
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Zhoba, Hryhoriy Bohdanovych, Brian P. Fleischer und Wesley B. Vanderlan. „Colorectal anastomotic perforation secondary to acute ruptured appendicitis presenting as septic arthritis“. Case Studies in Surgery 5, Nr. 2 (01.07.2019): 1. http://dx.doi.org/10.5430/css.v5n2p1.
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Anastomotic leaks following abdominoperineal resection with rectal anastomosis become clinically significant in 2.9%-22% of cases. Local recurrence of cancer and local inflammation are the most common causes of these leaks . Colonic perforation presenting with suppurative involvement of the lower extremities has been previously reported. We describe herein the case of a colorectal anastomotic leak secondary to pathology-proved acute appendicitis presenting with suppurative necessitation causing right hip septic arthritis five years following lower anterior resection (LAR) for stage unspecified colorectal cancer. No similar case has been demonstrated in the surveyed literature.
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Jones, Wesley B., Katherine M. Myers, L. Brannon Traxler und Eric S. Bour. „Clinical Results Using Bioabsorbable Staple Line Reinforcement for Circular Staplers“. American Surgeon 74, Nr. 6 (Juni 2008): 462–68. http://dx.doi.org/10.1177/000313480807400602.
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Although linear surgical staple line reinforcement has been shown to increase anastomotic tensile strength in animal models and reduce the incidence of staple line bleeding and anastomotic leaks in colorectal surgery, the benefits of staple line reinforcement on circular stapled anastomoses in bariatric surgery remain unreported in the literature. The purpose if this study was to compare the incidence of anastomotic bleeding, leak, and stricture in patients undergoing laparoscopic gastric bypass with circular staple line reinforcements with those with no circular staple line reinforcements. Since May 2006, 138 consecutive patients (Group B) have undergone laparoscopic Roux-en-Y divided gastric bypass with a 25-mm circular stapled gastrojejunal anastomosis using GORE SEAMGUARD® bioabsorbable circular staple line reinforcement (CBSG) with a mean follow up of 9 months. The incidence of anastomotic bleeding, leak, and stricture was compared with 255 similar patients (Group A) who underwent surgery before May 2006 without gastrojejunal reinforcement with a mean follow up of 22 months. The rates of anastomotic bleeding, leak, and stricture for Group B versus Group A were 0.7 per cent versus 1.1 per cent ( P = 0.64); 0.7 per cent versus 1.9 per cent ( P = 0.34); and 0.7 per cent versus 9.3 per cent ( P = 0.0005), respectively. The use of CBSG reduced the incidence of anastomotic stricture by 93 per cent and the incidence of a composite end point of all anastomotic complications by 85 per cent. Our results indicate that the use of circular staple line reinforcement at the gastrojejunal anastomosis in patients undergoing laparoscopic gastric bypass significantly decreases the incidence of anastomotic stricture and a composite end point of all anastomotic complications. On this basis, strong consideration should be given to the routine use of CBSG staple line reinforcement in patients undergoing laparoscopic divided gastric bypass with a circular stapled gastrojejunal anastomosis.
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Lin, Tzu-Hsin, und Pei-Ming Huang. „Early Postoperative Endoscopy for Evaluation of the Anastomosis after Esophageal Reconstruction“. Thoracic and Cardiovascular Surgeon 66, Nr. 05 (16.05.2017): 376–83. http://dx.doi.org/10.1055/s-0037-1602829.
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Background Anastomotic leaks significantly affect hospital stay after esophageal surgery. Here, we investigated the efficacy of early endoscopy for predicting anastomotic healing and leaks after esophageal reconstruction. Methods A total of 65 consecutive esophageal cancer patients treated by cervical esophagogastrostomy underwent routine endoscopy between postoperative days 5 and 7. The anastomosis was scored for the degree of ischemia, stenosis, and torsion of the anastomotic axis. Independent associations between ischemia, stenosis, and torsion of the proximal esophagus and the risk of the anastomotic leak were examined using Spearman's rank correlation method. Results Assessment of the degree of mucosal ischemia in 65 patients shows well healing in 35, patch ischemia in 20, diffuse ischemia in 10, no necrosis in any patient. Stenosis was classified as 0 to 10% in 40 patients, 11 to 20% in 12, 21 to 80% in 11, and 81 to 100% in 2. The degree of torsion of the anastomotic axis was classified as 0 to 10 degrees in 52 patients, 11 to 90 degrees in 8, and 91 to 180 degrees in 5. With rising endoscopy scores, there was an increase in risk for leaks (score > 4.5, sensitivity 100%, and specificity 83.8%). Conclusions Early postoperative endoscopy facilitates the management of esophagogastrostomy anastomosis to predict leaks.
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Ayhan, Barıs, Mehmet Erikoglu, Süleyman S. Tavlı und Hatice Toy. „A comparison of the application of fibrin glue and adhesive film for repair of anastomotic leaks in the rat“. Clinical & Investigative Medicine 35, Nr. 4 (04.08.2012): 216. http://dx.doi.org/10.25011/cim.v35i4.17150.
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Background: Anastomotic leaks constitute one of the most serious intraoperative complications and although many studies have been devoted to finding a solution for this problem, none of them has yet been able offer a decisive, successful method. In this study, the ability of fibrin glue and adhesive film to repair anastomotic leaks in an experimental model was compared. Materials and methods: The sample comprised four groups of seven rats: Group 1 (Control): the distal colon was transected and anastomosis was performed. Group 2 (Primary repair): incomplete anastomosis produced a leak that was closed by primary repair on day 3. Group 3 (Fibrin glue): incomplete anastomosis produced a leak that was closed by primary repair and fibrin glue applied on day 3. Group 4 (Adhesive film): incomplete anastomosis produced a leak that was closed by primary repair and adhesive film was applied on day 3. The rats were sacrificed on day 6 following anastomosis. Anastomotic blast compressions were measured and fibroblast activation, inflammation, neovascularization and levels of collagen were evaluated. Results: The results from Group 4 showed that blast compression values were high and statistically significantly increased over control values (p < 0.05). Inflammation in Group 2 was significantly higher than the other groups (p < 0.05). No significant differences were detected in the comparison of the groups regarding the other scoring criteria (p > 0.05). Conclusion: Adhesive film is more effective in reducing anastomotic leakage than fibrin glue.
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Jebin Aaron, Devarajan, Amaranathan Anandhi, Gubbi Shamanaa Sreenath, Sathasivam Sureshkumar, Oseen Hajilal Shaikh, Vairrappan Balasubramaniyan und Vikram Kate. „Serial estimation of serum C-reactive protein and procalcitonin for early detection of anastomotic leak after elective intestinal surgeries: a prospective cohort study“. Turkish Journal of Surgery 37, Nr. 1 (01.03.2021): 22–27. http://dx.doi.org/10.47717/turkjsurg.2021.5102.
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Objective: Anastomotic leak can adversely affect the outcome of surgery especially if detected late. The present study was carried out to detect the anastomotic leak early in the postoperative period using serial estimation of procalcitonin (PCT) and C-reactive protein (CRP). Material and Methods: A single centre prospective cohort study was done on patients undergoing elective gastrointestinal surgery with anastomosis. Serial estimation of serum procalcitonin and C reactive protein was done on the first five postoperative days. Other parameters such as hemoglobin, total protein, albumin and WBC counts were noted perioperatively. Patients were followed up to 60th postoperative day to assess for anastomotic leak, wound infection and other septic foci. Results: Eighty-four patients were included in the study. Anastomotic leak rate was 26.19% (22/84) and 3/22 patients died in the anastomotic leak group. Wound infection rate was 23.81%. The cut off value of CRP on third postoperative day in detecting anastomotic leak was 44.322 mg/dl with sensitivity of 72.73%, specificity of 66.13% and accuracy of 59.52%. The cut off value for WBC count measured perioperatively in detecting anastomotic leak was 9470 cell/mm3 with sensitivity of 72.73%, specificity of 56.45% and accuracy of 59.74%. Serum procalcitonin, haemoglobin, total protein and albumin measured were not sensitive enough to detect the anastomotic leak early. Conclusion: Measuring CRP on the third postoperative day can predict anastomotic leak with a cut off value of 44.32 mg/dl. Patients with raised CRP need careful evaluation to rule out anastomotic leak before deciding on early discharge.
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Hill, Joshua S., Erin Marie Hanna, Susie C. Hurley, Mark Reames und Jonathan C. Salo. „Relationship of drain amylase and anastomotic leak after esophagectomy.“ Journal of Clinical Oncology 31, Nr. 4_suppl (01.02.2013): 118. http://dx.doi.org/10.1200/jco.2013.31.4_suppl.118.
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118 Background: Esophagectomy is considered the only curative approach in patients with esophageal cancers without locally advanced or metastasis. Anastomotic leak can lead to significant morbidity and mortality. CT esophagram (CTE) is a sensitive method of evaluating for leak; however this test carries with it financial cost and radiation exposure. This study evaluates the utility of drain amylase in the prediction of anastomotic leak. Methods: Fifty-nine patients underwent esophagectomy between 3/10 and 8/12; serial drain amylases and CTE were obtained in 50. Leak was defined by extravasation of contrast or the presence of empyema on CTE. Elevated drain amylase was defined as any level > 400 IU/L. Chi-square and descriptive statistics were performed and the sensitivity of drain amylase >400 IU/L in predicting leak was calculated. Results: A minimally invasive esophagectomy was performed in 47, and an open Ivor-Lewis in 2 and a minimally invasive Ivor-Lewis in 1. Stapled intra-thoracic anastomoses were performed in 47, 3 had a cervical anastomoses. Average age was 61 years and 84% were males. Leak occurred in 6 patients (12.5%). One patient with a late leak was excluded from analysis as they did not have concurrent drain amylase values. This patient had low amylase levels and a normal CTE, though later presented with leak. The overall peri-operative mortality rate was 4.2% (2/48). Mortality in the non-leak and leak cohorts were 0% & 33%. Drain amylase was an accurate marker of anastomotic leak. Of 6 patients with an elevated drain amylase, 5 had an anastomotic leak (sensitivity 83.3%). 40/41 patients with low drain amylase had no leak. Using a cut-off value of 400 IU/L, the negative predictive value of drain amylase in predicting leak after esophagectomy was 97.6% (95%CI; 85.6, 99.9). Conclusions: Drain amylase is a simple and inexpensive test that has excellent sensitivity and negative prediction for the detection of anastomotic leak after esophagectomy. To our knowledge, this is the first study to demonstrate this finding. Routine evaluation of drain amylase may safely replace CTE in the management of patients after esophagectomy, thus reducing radiation exposure and overall cost.
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Ernst, Brenda, Helen J. Ross, Harshita Paripati, Rahul Pannala, William G. Rule, Jonathan Ben Ashman, Kristi L. Harold und Dawn E. Jaroszewski. „Endoscopic stenting for esophageal leak after minimally invasive esophagectomy.“ Journal of Clinical Oncology 34, Nr. 4_suppl (01.02.2016): 110. http://dx.doi.org/10.1200/jco.2016.34.4_suppl.110.
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110 Background: Anastomotic leaks can occur after esophagectomy and optimal management after minimally invasive esophagectomy (MIE) is not well defined. We reviewed endoscopic management of leaks after MIE in patients undergoing trimodality therapy at Mayo Clinic Arizona. Methods: Records of patients undergoing MIE from November, 2006 to February, 2015 were reviewed after appropriate IRB approval. Results: 148 patients underwent MIE including 136 (91.8%) thoracic and 12 (8.1%) cervical anastomoses. Clinically significant anastomotic leaks were observed in 13 (8.8%) patients with 2 (16%) cervical and 11 (8%) thoracic anastomosis at a median of 6.1 days (0-14). 11 (11%) patients treated with neoadjuvant chemoradiotherapy experienced esophageal leak and 2 who did not receive chemoradiotherapy (4%). For treatment of anastomotic leaks, 10 patients underwent VATS with pleural space irrigation and chest tube replacement, and 11 patients underwent stent deployment at the anastomosis for repair. Stents were placed such that the fistula/leak was in the fully covered portion with the greater portion of the stent residing in the esophageal remnant. Stents were removed at a mean of 54 days (28-114). In 2 patients, overgrowth into the stent body required stent-in-stent placement (fully covered) with removal of both stents. Stents were successful at sealing all leaks. Conclusions: Leaks after MIE represent a small, but significant, morbidity in MIE. The majority can be managed by endoscopic stent placement. Stenting is an effective management tool for postoperative leaks in locally advanced esophageal malignancies.
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Katasani, V. G., R. R. Leeth, D. S. Tishler, T. D. Leath, B. P. Roy, C. L. Canon, S. M. Vickers und R. H. Clements. „Water-Soluble Upper GI Based on Clinical Findings is Reliable to Detect Anastomotic Leaks after Laparoscopic Gastric Bypass“. American Surgeon 71, Nr. 11 (November 2005): 916–19. http://dx.doi.org/10.1177/000313480507101104.
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Anastomotic leak after laparoscopic Roux- en-Y gastric bypass (LGB) is a major complication that must be recognized and treated early for best results. There is controversy in the literature regarding the reliability of upper GI series (UGI) in diagnosing leaks. LGB was performed in patients meeting NIH criteria for the surgical treatment of morbid obesity. All leaks identified at the time of surgery were repaired with suture and retested. Drains were placed at the surgeon's discretion. Postoperatively, UGI was performed by an experienced radiologist if there was a clinical suspicion of leak. From September 2001 until October 2004, a total of 553 patients (age 40.4 ± 9.2 years, BMI 48.6 ± 7.2) underwent LGB at UAB. Seventy-eight per cent (431 of 553) of patients had no clinical evidence suggesting anastomotic leak and were managed expectantly. Twenty-two per cent (122 of 553) of patients met at least one inclusion criteria for leak and underwent UGI. Four of 122 patients (3.2%) had a leak, two from anastomosis and two from the perforation of the stapled end of the Roux limb. No patient returned to the operating room without a positive UGI. High clinical suspicion and selectively performed UGI based on clinical evidence is reliable in detecting leaks.
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McCarter, Martin, Carrie Ryan, Robert Meguid und Alessandro Paniccia. „Transthoracic anastomotic leak after esophagectomy: Still a catastrophe?“ Journal of Clinical Oncology 34, Nr. 4_suppl (01.02.2016): 126. http://dx.doi.org/10.1200/jco.2016.34.4_suppl.126.
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126 Background: Leaks from intrathoracic esophagogastric anastomosis are thought to be associated with higher rates of morbidity and mortality than leaks from cervical anastomosis. We challenge this assumption, and hypothesize that there is no significant difference in mortality based on the position of the esophagogastric anastomosis. Methods: A systematic literature search was conducted using PubMed and Embase databases on all studies published between January 2000 and June 2015 comparing transthoracic (TTE) and transhiatal (THE) esophagectomies. Studies that used alternate reconstruction approaches were excluded. Outcomes analyzed were leak rate, leak-associated mortality, overall 30-day mortality, and overall morbidity. Meta-analyses were performed using Mantel Haenszel statistical analyses on studies that reported on leak rates of both approaches. Nominal data are presented as frequency and interquartile range (IQR); measures of the association between treatments and outcomes are presented as odds ratio (OR) with 95% confidence interval (CI). Results: Twenty-one studies (including 3 randomized controlled trials) were included comprising of 7167 patients (54% TTE). THE approach yields a higher anastomotic leak rate (12%; IQR: 11.6% - 22.1%) than TTE (9.8%; IQR: 6.0% - 12.2%) (OR: 1.83 [0.34-06.92]), without any difference in leak-associated mortality (7.1% TTE vs. 4.6% THE; OR: 1.83, [0.39-8.52]). There was no difference in overall 30-day mortality (3.9% TTE vs. 4.3% THE; OR: 0.86, [0.66-1.13]) and morbidity (59.0% TTE vs. 66.6% THE; OR: 0.76, [0.37-1.59]). Conclusions: Transthoracic esophagectomy is associated with a lower leak rate and does not result in higher morbidity or mortality than transhiatal esophagectomy. The previously assumed higher rate of transthoracic leak-associated mortality is overstated, thus allowing surgeon discretion and other factors to influence the choice of intrathoracic versus cervical esophagogastric anastomosis.
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Caulfield, Hannah, und Neil H. Hyman. „Anastomotic Leak After Low Anterior Resection“. JAMA Surgery 148, Nr. 2 (01.02.2013): 177. http://dx.doi.org/10.1001/jamasurgery.2013.413.
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Ricciardi, Rocco. „Anastomotic Leak Testing After Colorectal Resection“. Archives of Surgery 144, Nr. 5 (18.05.2009): 407. http://dx.doi.org/10.1001/archsurg.2009.43.
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Agarwal, BrijB, SandeepK Jha, Sneh Agarwal, Karan Goyal und Chintamani. „Esophagectomy: Anastomotic leak, stent the rent!“ Saudi Journal of Gastroenterology 20, Nr. 1 (2014): 1. http://dx.doi.org/10.4103/1319-3767.126304.
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Power, N., M. Atri, S. Ryan, R. Haddad und A. Smith. „CT assessment of anastomotic bowel leak“. Clinical Radiology 62, Nr. 1 (Januar 2007): 37–42. http://dx.doi.org/10.1016/j.crad.2006.08.004.
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