The intraperitoneal lactate/pyruvate ratio and cytokines, IL-6, IL-10, and TNF-alpha, were increased in patients who developed symptomatic anastomotic leakage before clinical symptoms were evident.

In evaluating postoperative metabolism, intraperitoneal microdialysis is influenced by the location of the microdialysis catheter. The same pattern is, however, recorded over time. The juxta-anastomotic region and the small intestinal loop area seem to be the most reasonable locations for measurements.

The aim of the study was to fi nd laboratory samples for early diagnosis of anastomotic leak. Summary background data: Anastomotic leakage after rectal cancer surgery is a severe complication with high mortality. Outcome is highly dependent on early diagnosis. Methods: 29 patients were investigated postoperatively after having undergone low anterior resection due to cancer recti. Patient outcomes were divided into three groups: Anastomotic leak in 7 patients, other complications in 9 patients and 13 patients who were free of complications. Patients were monitored every 6 th hour with blood and intraperitoneal samples in order to identify laboratory markers for early detection of anastomotic leakage. An anastomotic leak index was created, a scoring system where points count for values higher than reference values of CRP and interleukin 6 in blood and intraperitoneal lactate, lactate/ pyruvate ratio and interleukin 6 were measured at 18, 24, 42 and 48 hours postoperatively. Results: Signifi cant differences between groups were found regarding CRP, Interleukin 6, fi brinogen and D-dimer in blood. Intraperitoneal differences were found not only in lactate and lactate/pyruvate ratio measured by microdialysis, signifi cant differences in interleukin 6, interleukin 10 and tumour necrosis factor-α could also be demonstrated between the groups. The anastomotic leak index had a sensitivity and specifi city of 86% (p=0.0007). Conclusions: The most important factor was time after operation. No laboratory parameter in itself could predict an anastomotic leak but the anastomotic leak index was a useful tool in the monitoring and assessment of clinical outcome.

No abstract