Anastomotic leak in patients with acute complicated diverticulitis undergoing primary anastomosis: risk factors and the role of diverting loop ileostomy

Hoffman, Rebecca L.; Consuegra, Hadassah; Long, Kevin; Buzas, Christopher J.

doi:10.1007/s00384-021-03957-z

Cited by 5 publications

(3 citation statements)

References 28 publications

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“…They found that 3.8% of patients leaked, of whom 19.4% were managed medically, 24.5% were managed with nonsurgical intervention, and 56.1% underwent reoperation. They found that creation of a diverting stoma during the initial operation was associated with decreased need for reoperation, which is consistent with our data and other studies [13–16]. They also found that colocolonic anastomotic leaks had a higher risk of reoperation compared to ileocolic leaks.…”

Section: Discussionsupporting

confidence: 92%

Operative management of anastomotic leak after sigmoid colectomy for left‐sided diverticular disease: Ileostomy creation may be as safe as colostomy creation

et al. 2023

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Aim The management of anastomotic leak after sigmoid colectomy for diverticular disease has not been well defined. Specifically, there is a lack of literature on optimal types of reoperations for leaks. The aim of this study was to describe and compare reoperative approaches and their postoperative outcomes. Methods We performed a retrospective cohort study using the NSQIP Colectomy Module (2012–2019) and single‐institution chart review. Patients with diverticular disease who underwent elective sigmoid colectomy were included. Primary outcomes were anastomotic leak requiring reoperation and management of anastomotic leak. Results Of 37,471 patients who underwent sigmoid colectomy for diverticular disease, 1003 (2.7%) suffered an anastomotic leak, of whom 583 underwent reoperation. Of the 572 patients who were not initially diverted and underwent reoperation for leak, 302 (52.8%) were managed with stoma creation – 200 (35.0%) with colostomy and 102 (17.8%) with ileostomy. The remaining 47.2% underwent colectomy with reanastomosis, suturing of large bowel, and drainage. There were no differences in length of stay, readmission, or mortality between patients who underwent ileostomy or colostomy at reoperation (p > 0.05). Single‐institution analysis demonstrated that 100% of patients with ileostomies underwent subsequent ileostomy closure, compared to 60% of patients with colostomies. Conclusions In patients who suffer anastomotic leaks after sigmoid colectomy for diverticular disease and undergo reoperations, ileostomy at the time of reoperation appears to be safe, with comparable results to colostomy. Ileostomies were more frequently closed than colostomies. When faced with a colorectal anastomotic leak, ileostomy creation may be considered.

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Section: Discussionsupporting

confidence: 92%

Operative management of anastomotic leak after sigmoid colectomy for left‐sided diverticular disease: Ileostomy creation may be as safe as colostomy creation

et al. 2023

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“…This raises the question of the need for this type of stoma. A meta-analysis conducted since the relationship between age and anastomotic stenosis following diverticulitis surgery was reported did not even prove its role in reducing postoperative morbidity in patients undergoing left-sided colon resection and anastomosis for diverticulitis [28], while another highlighted the fact that it could reduce the risk of reoperation [29]. The World Society of Emergency Surgery guidelines for the management of acute colonic diverticulitis in the emergency setting recommend that primary resection with anastomosis with or without a diverting stoma should be performed, with low-quality evidence (2B) [25].…”

Section: Discussionmentioning

confidence: 99%

Stenosis of the colorectal anastomosis after surgery for diverticulitis: A national retrospective cohort study

Hamel,

Alves,

Beyer‐Bergot

et al. 2024

Colorectal Disease

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AimThe aim of this work was to investigate the association between early postoperative anastomotic leakage or pelvic abscess (AL/PA) and symptomatic anastomotic stenosis (SAS) in patients after surgery for left colonic diverticulitis.MethodThis is a retrospective study based on a national cohort of diverticulitis surgery patients carried out by the Association Française de Chirurgie. The assessment was performed using path analyses. The database included 7053 patients operated on for colonic diverticulitis, with surgery performed electively or in an emergency, by open access or laparoscopically. Patients were excluded from the study analysis where there was (i) right‐sided diverticulitis (the initial database included all consecutive patients operated on for colonic diverticulitis), (ii) no anastomosis was performed during the first procedure or (iii) missing information about stenosis, postoperative abscess or anastomotic leakage.ResultsOf the 4441 patients who were included in the final analysis, AL/PA occurred in 327 (4.6%) and SAS occurred in 82 (1.8%). AL/PA was a significant independent factor associated with a risk for occurrence of SAS (OR = 3.41, 95% CI = 1.75–6.66), as was the case for diverting stoma for ≥100 days (OR = 2.77, 95% CI = 1.32–5.82), while central vessel ligation proximal to the inferior mesenteric artery was associated with a reduced risk (OR = 0.41; 95% CI = 0.19–0.88). Diverting stoma created for <100 days or ≥100 days was also a factor associated with a risk for AL/PA (OR = 3.08, 95% CI = 2–4.75 and OR = 12.95, 95% CI = 9.11–18.50). Interestingly, no significant association between radiological drainage or surgical management of AL/PA and SAS could be highlighted.ConclusionAL/PA was an independent factor associated with the risk for SAS. The treatment of AL/PA was not associated with the occurrence of anastomotic stenosis. Diverting stoma was associated with an increased risk of both AL/PA and SAS, especially if it was left for ≥100 days. Physicians must be aware of this information in order to decide on the best course of action when creating a stoma during elective or emergency surgery.

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“…One study using ACS-NSQIP data examined 497 patients with acute complicated diverticulitis who underwent resection and primary anastomosis, with and without diverting loop ileostomy. 65 Current smoking, defined as cigarette use within the last year, was associated with 4.02 times the likelihood of anastomotic leak (95% CI: 1.44–11.26) compared with nonsmokers. Another study of over 9,000 patients undergoing a range of colorectal operations at 64 Michigan hospitals found that current tobacco use conferred a 1.59 increased odds of anastomotic leak (95% CI: 1.2–2.1).…”

Section: Risks Of Smoking In the Perioperative Periodmentioning

confidence: 95%

Smoking Cessation for Preoperative Optimization

Lussiez

2023

Clin Colon Rectal Surg

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Cigarette smoking is associated with pulmonary and cardiovascular disease and confers increased postoperative morbidity and mortality. Smoking cessation in the weeks before surgery can mitigate these risks, and surgeons should screen patients for smoking before a scheduled operation so that appropriate smoking cessation education and resources can be given. Interventions that combine nicotine replacement therapy, pharmacotherapy, and counseling are effective to achieve durable smoking cessation. When trying to stop smoking in the preoperative period, surgical patients experience much higher than average cessation rates compared with the general population, indicating that the time around surgery is ripe for motivating and sustaining behavior change. This chapter summarizes the impact of smoking on postoperative outcomes in abdominal and colorectal surgery, the benefits of smoking cessation, and the impact of interventions aimed to reduce smoking before surgery.

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Anastomotic leak in patients with acute complicated diverticulitis undergoing primary anastomosis: risk factors and the role of diverting loop ileostomy

Cited by 5 publications

References 28 publications

Operative management of anastomotic leak after sigmoid colectomy for left‐sided diverticular disease: Ileostomy creation may be as safe as colostomy creation

Operative management of anastomotic leak after sigmoid colectomy for left‐sided diverticular disease: Ileostomy creation may be as safe as colostomy creation

Stenosis of the colorectal anastomosis after surgery for diverticulitis: A national retrospective cohort study

Smoking Cessation for Preoperative Optimization

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