Drain fluid amylase as a biomarker for the detection of anastomotic leakage after rectal resection without a diverting ileostomy

Abstract

Background Anastomotic leak (AL) is the anathema of colorectal surgery. Early diagnosis is an essential segue to early intervention. A temporary diverting ileostomy (TDI) does not prevent an AL and presents inherent complications of its own. Numerous drain fluid biomarkers (BM) have been studied in colorectal surgery and extravasated intraluminal substances (EILS) such as amylase have shown promise. The aim of this study was to assess drain fluid amylase (DFA) as a BM of AL after minimally invasive rectal resection without a TDI. Methods A single centre prospective cohort study performed from 2018 to 2021. The primary outcome was DFA measured daily whilst the drain was in situ. Rectal tube amylase was also measured for the first two post‐operative days to quantitate the intra‐luminal levels of the enzyme. DFA was compared between patients who experienced AL and those who did not. Results Of the 62 patients studied, six (9.7%) experienced AL. There was a statistically significant difference in DFA between patients who experienced AL (Median:1373.5 U/L; IQR: 306–7953) and patients who did not experience an AL (Median: 27.0 U/L; IQR: 16–38); p < 0.0001. Conclusions The measurement of drain fluid amylase is a highly sensitive BM of early clinical anastomotic leak in patients undergoing a rectal resection with an extraperitoneal anastomosis and when a TDI is not incorporated. This simple, inexpensive and non‐invasive test should be considered in all patients as an adjunct to the clinical diagnosis and differentiation of AL from other postoperative complications.

CRP in Drain Fluid as a Predictive Marker of Anastomotic Leak in Colorectal Surgery: A Systematic Review of the Literature

“…Other laboratory biomarkers such as the neutrophil-tolymphocyte ratio and drain fluid amylase have been investigated and proven to be indicators of worse outcomes after colorectal surgery, having a close correlation to patients' morbidity and AL. These markers demonstrated their highest sensitivity and specificity on POD 4 and 5 (18,19).…”

Does an ileostomy cover the surgeon or the anastomosis?

“…The measurement of drain fluid amylase or drain fluid Gastrografin may achieve this end and there is emerging evidence of their utility as sensitive BMs for early AL. [17][18][19][20][21] Patients without a TDI are likely to present more dramatically and earlier in their post-operative recovery.…”

Early Detection and Monitoring of Anastomotic Leaks via Naked Eye‐Readable, Non‐Electronic Macromolecular Network Sensors

“…Particularly in strenuous times when hospitals are understaffed, this discontinuous monitoring, which requires active involvement of hospital staff, can significantly increase the risk of late AL detection, negatively impacting patient recovery and outcomes. While amylase has become an established biomarker, [26] the diagnostic potential (as a function of type of surgery) for trypsin and lipase are yet to be comprehensively analyzed in clinical settings.…”