Laparoscopic reintervention for anastomotic leakage after primary laparoscopic colorectal surgery

Wind, Jan; Koopman, A. G.; Henegouwen, Mark I. van Berge; Slors, J. F. M.; Gouma, Dirk J.; Bemelman, Willem A.

doi:10.1002/bjs.5892

Cited by 66 publications

(55 citation statements)

References 20 publications

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“…Local repair of a leaking anastomosis was condemned in the literature until some support of anastomotic preservation appeared [13,27]. Wind et al [27] showed that of 25 patients who were re-operated for CAL, 11 were treated with preserving the anastomosis, without any sign of recurrence of leakage.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of Colorectal Anastomotic Leakage: Results of a Questionnaire amongst Members of the Dutch Society of Gastrointestinal Surgery

et al. 2012

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Anastomotic leakage after colorectal surgery is correlated with considerable morbidity and mortality. Although many studies focus on risk factors and detection, studies on the treatment strategy for colorectal anastomotic leakage are scarce. A national questionnaire amongst 350 members of the Dutch Society for Gastrointestinal Surgery was undertaken on the current treatment of colorectal anastomotic leakage. The response was 40% after two anonymous rounds. 27% of the respondents state that a leaking anastomosis above the level of the promontory should be salvaged in ASA 1-2 patients <80 years of age, for ASA 3 and/or >80 years of age this percentage is 7.3%. For an anastomosis under the promontory, 50% of the respondents choose preserving the anastomosis for ASA 1-2 compared to 17% for ASA 3 and/or >80 years of age. In ASA 1-2 patients with a local abscess after a rectum resection without protective ileostomy, 31% of the respondents will create an protective ileostomy, 40% break down the anastomosis to create a definite colostomy, in ASA 3 and/or >80 years of age 14% of the respondents create a protective ileostomy and 63% a definitive colostomy. In ASA 1-2 patients with peritonitis after a rectum resection with deviating ileostomy, 31% prefer a laparotomy for lavage and repair of the anastomosis, 25% for lavage without repair and 36% of the respondents prefer to break down the anastomosis. When the patient is ASA 3 and/or >80 years of age, 13% prefer repair, 9% a lavage and 74% breaking down the anastomosis. This questionnaire shows that in contrast to older people, more surgeons make an effort to preserve the anastomosis in younger people.

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Section: Discussionmentioning

confidence: 99%

“…Wind et al [27] showed that of 25 patients who were re-operated for CAL, 11 were treated with preserving the anastomosis, without any sign of recurrence of leakage. In contrast to this, Rickert et al [14] recently have shown that re-leakage occurred in 5 of 9 patients in which repair was attempted.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Colorectal Anastomotic Leakage: Results of a Questionnaire amongst Members of the Dutch Society of Gastrointestinal Surgery

et al. 2012

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“…In our first 65 cases, our complication rates were similar with literature. Wind et al [9] reported an anastomotic leakage rate of 20%. To our study, first two cases applying right colectomy, anastomotic leakage (approximately 5%) was observed.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic colorectal surgery outcomes in our first 65 case comparing with literature

Yılmaz¹

2018

Eu Clin Anal Med

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anterior resection (AR) in 19 cases (29,2%), right colectomy in 18 cases (27,6%), abdomino-perineal resection (APR) in 5 cases (7,7%), colloanal anastomosis in 2 cases, total colectomy in 1 case (1.6%) were performed. It have been showed anastomotic leakage in 3 cases (4,6%), wound infection in 10 cases (15.3%), 3 patient incisional hernia (4,6%), ureter injury in a patient (1.5%) and urethra injury in a patient (1.5%). There was no mortality. Discussion: Although our experience with laparoscopic colorectal surgery is compatible with the literature and is not yet gold standard, we think that it gives better results than open surgery due to its advantages. Keywords

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“…However, abdominal re-exploration by laparotomic access may increase morbidity such as postoperative abdominal pain, wounds infections, sepsis, abnormal wound healing and increased rate of incisional hernia, prolonged ileus, respiratory failure and prolonged bed rest and hospital stay [18]. Relaparoscopic approach is simple, and if negative do not increase morbidity, it could reduce an additional surgical trauma and could avoid further complications in patients suffered of postoperative complications needing a redo surgery; when done early, the old port is still open and accessible, and pneumoperitoneum can be achieved bluntly [19,20]. A recent laparotomy could not be a contraindication to a mini-invasive laparoscopic management of general surgery postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

“Relaparoscopic” management of surgical complications: The experience of an Emergency Center

et al. 2015

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Background/aim Laparotomy has been the approach of choice for re-operations in patients with surgical complications. The aim of this retrospective analysis was to evaluate the feasibility and the safety of laparoscopic approach for the management of general abdominal surgery complications. Materials and methods We report a retrospective review of 75 patients who underwent laparoscopic evaluation for postoperative complications over a 4-year period. Primary outcomes (resolution rate by exclusive laparoscopic approach, conversion rate, further surgery rate) and secondary outcomes (mortality, hospitalization, prolonged ileus, wounds problems and median operative time) were evaluated. Results Sixty-six patients (88 %) were managed with laparoscopic approach without conversion; of these, sixtythree patients (84 %) had no more or further complications and were discharged from hospital between 4 ± 3 days after ''second-look'' surgery; three patients (4 %) developed postoperative complications requiring a third surgery.Nine cases (12 %) underwent conversion in open surgery after laparoscopic approach. Two elderly patients (2.7 %) died in intensive care unit, because of multi-organ failure syndrome. Median time elapsed between an intervention and another was about 2.5 ± 9.5 days. Mean operative time was 90 ± 150 min. Postoperative hospital stay was between 4.5 and 18 days. Discussion and conclusion Laparoscopy has begun to be the preferred method to manage postoperative problems, but only few reports are available actually. Our experience in ''relaparoscopic'' management of surgical complications seems to suggest that laparoscopy ''second look'' is an effective tool after open or laparoscopic surgery for the management of postoperative complications and it may avoid diagnostic delay and further laparotomy and related problems.

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Laparoscopic reintervention for anastomotic leakage after primary laparoscopic colorectal surgery

Abstract: These data suggest that laparoscopic reintervention for anastomotic leakage after primary laparoscopic surgery is associated with less morbidity, faster recovery and fewer abdominal wall complications than relaparotomy.

Cited by 66 publications

References 20 publications

Treatment of Colorectal Anastomotic Leakage: Results of a Questionnaire amongst Members of the Dutch Society of Gastrointestinal Surgery

Treatment of Colorectal Anastomotic Leakage: Results of a Questionnaire amongst Members of the Dutch Society of Gastrointestinal Surgery

Laparoscopic colorectal surgery outcomes in our first 65 case comparing with literature

“Relaparoscopic” management of surgical complications: The experience of an Emergency Center

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