Colorectal Surgery and Anastomotic Leakage

“…To assess the gravity of AL the classification described by Soeters et al [34] was used which includes four progressive severity grades (Table 1). When assess- in 187 patients (39.6%), and of these 187, 18 (9.6%) were done using a short-term protocol (2,000 rad over 5 days followed by immediate surgery, and 169 (90.4%) were done using a long-term protocol (4,000-4,500 rad over 5 weeks followed by a waiting period of 6-8 weeks) combined with chemotherapy in 164.…”

Section: Study Populationmentioning

confidence: 99%

Anastomotic leaks after anterior resection for mid and low rectal cancer: survey of the Italian Society of Colorectal Surgery

Asteria

Gagliardi²,

Pucciarelli³

et al. 2008

Tech Coloproctol

View full text Add to dashboard Cite

univariate and multivariate analyses. Further analysis was conducted on patients with AL to identify factors correlated with gravity. Results There were 520 patients representing 64% of LAR for rectal cancer performed by SICCR members. The overall rate of AL was 15.2%. Mortality was 2.7% including 0.6% from AL. The incidence of AL was correlated with higher age (p<0.05), lower (<20 per year) centre case volume (p<0.05), obesity (p<0.05), malnutrition (p<0.01) and intraoperative contamination (p<0.05), and was lower in patients with a colonic J-pouch reservoir (p<0.05). In the multivariate analysis age, malnutrition and intraoperative contamination were independent predictors. The only predictor of severe (grade III/IV) AL was alcohol/smoking habits (p<0.05) while the absence of a diverting stoma was borderline significant (p<0.07). Conclusions Our retrospective survey identified several risk factors for AL. This survey was a necessary step to construct prospective interventional studies and to establish benchmark standards for outcome studies. Keywords Anastomotic leaks · Low anterior resection · Rectal cancer · Outcome studies IntroductionAnastomotic leakage (AL) is the most significant surgical complication following resection for rectal cancer [1], affecting perioperative mortality and possibly longterm survival [2,3]. The rate of AL after anterior resection (AR) varies from 3% to 19% [4][5][6][7][8][9][10][11], being clinically significant in 2.9-15.3% of patients. Mortality following a leak may be 6.0-39.3% [12]. Most of the reports of complications after surgery for colorectal cancer come Abstract Background The aim of the survey was to assess the incidence of anastomotic leaks (AL) and to identify risk factors predicting incidence and gravity of AL after low anterior resection (LAR) for rectal cancer performed by colorectal surgeons of the Italian Society of Colorectal Surgery (SICCR). Methods Information about patients with rectal cancers less than 12 cm from the anal verge who underwent LAR during 2005 was collected retrospectively. AL was classified as grade I to IV according to gravity. Fifteen clinical variables were examined by ing factors predicting the gravity of AL among patients with AL this classification was simplified to mild to moderate (grades 1 and 2) and severe (grades 3 and 4).Categorical variables were evaluated using either Fisher's exact test or Pearson's chi-squared test depending on sample size. Numerical variables were evaluated using Student's t-test. P values <0.05 were considered significant. All variables which were associated with the incidence or gravity of AL in the univariate analysis were entered into a multivariate logistic regression model. Data were analysed using the STATA program (release 8.0, 2003; Stata Corporation, College Station, TX). ResultsOf 108 centres contacted, 44 (40.7%) participated. Information on 682 patients with rectal cancer who had undergone surgery was collected. Sphincter-saving surgery was performed in 579 patients (84.9%). After excluding abdom...

show abstract

“…die durchgeführte Nahttechnik, die Durchblutung der Anastomose, Ausbildung eines Hämatoms, elektrisch-thermische Nekrosen, Gewebsischämie, Kontamination und eine nicht spannungsfrei angelegte Anastomose. Als systemische Faktoren gelten schlechter Ernährungszustand, Rauchen, hohes Alter, Begleiterkrankungen, Medikamente (insbesondere Antikoagulanzien, Immunsuppressiva, Zytostatika) und Störungen des Kollagenstoffwechsels [33,34,35]. Als Ursache für frühe Anastomoseninsuffizienzen (2.-5. postoperativer Tag) gelten operativ-technische Prob- [29].…”

Section: Inzidenz Und Risikofaktorenunclassified

Insuffizienzen nach Eingriffen am unteren Gastrointestinaltrakt

Willis

Stumpf

2004

Chirurg

View full text Add to dashboard Cite

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.

show abstract

Colorectal Surgery and Anastomotic Leakage

Cited by 74 publications

References 11 publications

Laparoscopic reintervention for anastomotic leakage after primary laparoscopic colorectal surgery

Laparoscopic reintervention for anastomotic leakage after primary laparoscopic colorectal surgery

Anastomotic leaks after anterior resection for mid and low rectal cancer: survey of the Italian Society of Colorectal Surgery

Insuffizienzen nach Eingriffen am unteren Gastrointestinaltrakt

Contact Info

Product

Resources

About