Anastomotic leaks in colorectal cancer surgery: a risk factor for recurrence?

Akyol, Ahmet; McGregor, John R.; Galloway, D. J.; Murray, Gordon D.; George, W D

doi:10.1007/bf00341385

Cited by 110 publications

(93 citation statements)

References 15 publications

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“…In größeren Studien waren Anastomosenkomplikationen in 3-66% für einen letalen Krankheitsverlauf verantwortlich [4,20,23,26], zusätzlich wurden sie für eine erhöhte Rate am Tumorrezidiven [2] und schlechte funktionelle Ergebnisse verantwortlich gemacht [24]. Die Angaben über die Häufigkeit des Auftretens von Anastomoseninsuffizienzen variieren in Abhän-gigkeit von ihrer Lokalisation [26].…”

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Insuffizienzen nach Eingriffen am unteren Gastrointestinaltrakt

Willis

Stumpf

2004

Chirurg

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The incidence of anastomotic leakage in colorectal surgery is 1% to 12%. Every deviation from the normal postoperative course must raise suspicion of a leak. Diagnosis is made radiologically by rectal enema or CT. Limited leakages without clinical signs can be treated conservatively by wait-and-see. Larger anastomotic failure with intra-abdominal abscesses or peritonitis requires reanastomosis in combination with a diverting loop ileostomy or colostomy. A Hartmann procedure with open abdominal management may be indicated in severely ill patients with feculent peritonitis. In the pelvis, even large leaks may heal spontaneously when stool passage is diminished by a proximal diverting enterostomy. There is no benefit of primary loop enterostomies concerning the incidence of anastomotic leaks; however, they reduce the number of operative revisions due to anastomotic failure. Therefore they are proposed in risk patients and intraoperatively difficult anastomoses.

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Insuffizienzen nach Eingriffen am unteren Gastrointestinaltrakt

Willis

Stumpf

2004

Chirurg

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“…The septic consequences of anastomotic failure are associated with significant mortality and morbidity rates [9], with reported mortality rates varying between 6 and 22% [10]. In addition, it has been shown that anastomotic failure increases the recurrence rates and decreases tumour-free survival rates [11,12,13]. …”

Section: Introductionmentioning

confidence: 99%

Routine Use of Gastrograffin Enema prior to the Reversal of a Loop Ileostomy

et al. 2007

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Background/Aims: Anastomotic failure occurs in up to 10% of patients following anterior resection. Selective use of a loop ileostomy may reduce the septic consequences of anastomotic leak. The use of gastrograffin enema to confirm the anastomotic integrity prior to ileostomy closure is still controversial. Our aim was to determine the impact of the routine use of gastrograffin enema on patients’ management prior to ileostomy reversal. Methods: A review of 81 patients who underwent low anterior resection with loop ileostomy for rectal cancer over 3 years. Results: Gastrograffin enema was performed in 69 patients (85.2%). The mean time from operation to gastrograffin enema was 22 weeks. Four patients (5.8%) had a positive radiological leak without clinical suspicion of anastomotic problems, 2 patients (2.9%) of these subsequently had the ileostomy closed despite the positive result, 2 patients (2.9%) had a gastrograffin enema repeated which showed no leak and the patients are awaiting reversal. Conclusion: The incidence of positive radiological leak in uncomplicated patients is low; such patients had their loop ileostomies closed with or without serial gastrograffin enema. Routine gastrograffin enema in the absence of a clinical suspicion of anastomotic failure would appear to be of little value.

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“…Fewer reoperations for postoperative bleeding or leakage may be expected as well, thus reducing the hospital stay. Increased recurrence of malignancy is seen after leakage of colorectal anastomosis, which has been attributed to spill of tumor cells through the anastomotic site [60,61,62,63]. If the incidence of leakage can be reduced as a result of staple line reinforcement, it seems likely that there would be a positive effect on tumor recurrence as well.…”

Section: Discussionmentioning

confidence: 99%

Buttressing of the Staple Line in Gastrointestinal Anastomoses: Overview of New Technology Designed to Reduce Perioperative Complications

Consten

Ufford

et al. 2006

Dig Surg

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Background: Mechanical stapling devices are widely used in all fields of surgery as they can cut and sew tissue in a quick and easy manner. However, complications like bleeding or leakage at the staple line are frequently encountered and can have devastating consequences. Recent developments have led to the introduction of staple line reinforcement to reduce these complications. Methods: The literature has been reviewed to find and describe different methods to improve stapled resections and to give an extensive overview of the different staple line reinforcement materials, their properties and indications. Results: Several types of staple line reinforcement are available. Reinforcement of the staple line with membranes of either non-, semi- or absorbable material seems to be effective in minimizing the risk of leakage and bleeding by providing strength to the cut tissue. Conclusion: Application of staple line reinforcement material seems a promising technique in preventing leakage and bleeding at the stapled suture line, thus potentially reducing complications of gastrointestinal surgery. More studies are needed to investigate the exact properties, behavior and effects of the staple line reinforcement material.

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Anastomotic leaks in colorectal cancer surgery: a risk factor for recurrence?

Cited by 110 publications

References 15 publications

Insuffizienzen nach Eingriffen am unteren Gastrointestinaltrakt

Insuffizienzen nach Eingriffen am unteren Gastrointestinaltrakt

Routine Use of Gastrograffin Enema prior to the Reversal of a Loop Ileostomy

Buttressing of the Staple Line in Gastrointestinal Anastomoses: Overview of New Technology Designed to Reduce Perioperative Complications

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