Management and 1-year outcomes of anastomotic leakage after elective colorectal surgery

Borghi, Felice; Migliore, M.; Cianflocca, Desirée; Ruffo, Giacomo; Patriti, Alberto; Delrio, Paolo; Scatizzi, Marco; Mancini, Stefano; Garulli, Gianluca; Lucchi, Andrea; Carrara, Alessandro; Pirozzi, Felice; Scabini, Stefano; Liverani, Andrea; Baiocchi, Gian Luca; Campagnacci, Roberto; Muratore, Andrea; Longo, Graziano; Caricato, Marco; Palmieri, Raffaele; Vettoretto, Nereo; Ciano, Paolo; Benedetti, Michele; Bertocchi, Elisa; Ceccaroni, Marcello; Pace, Ugo; Pandolfini, Lorenzo; Sagnotta, Andrea; Pirrera, Basilio; Alagna, Vincenzo; Martorelli, Giacomo; Tirone, Giuseppe; Motter, Michele; Sciuto, Antonio; Martino, Antonio; Scarinci, Andrea; Molfino, Sarah; Maurizi, Angela; Marsanic, Patrizia; Tomassini, Federico; Santoni, Simone; Capolupo, Gabriella Teresa; Amodio, Pietro Maria; Arici, Elisa; Cicconi, Simone; Marziali, Irene; Guercioni, Gianluca; Catarci, Marco

doi:10.1007/s00384-020-03777-7

Cited by 6 publications

(5 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Second, the relatively low caseload, especially with regard to the CRLR group, limits the generalizability of our findings. Finally, perioperative management pathways were not standardized among institutions [37], and the general outcomes may have been influenced by this issue, at least in part.…”

Section: Discussionmentioning

confidence: 99%

The impact of synchronous liver resection on the risk of anastomotic leakage following elective colorectal resection. A propensity score match analysis on behalf of the iCral study group

Guerra

Petrelli

Greco

et al. 2021

European Journal of Surgical Oncology

Self Cite

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

The impact of synchronous liver resection on the risk of anastomotic leakage following elective colorectal resection. A propensity score match analysis on behalf of the iCral study group

Guerra

Petrelli

Greco

et al. 2021

European Journal of Surgical Oncology

Self Cite

View full text Add to dashboard Cite

“…AL is associated with life threatening intra-abdominal peritonitis, sepsis, and multiorgan failure requiring the need for ICU admission for organ support in the postoperative period ( 48 ). In fact, one study reported that the unplanned ICU admission rate associated with AL was 30.3% ( 49 ). Another study of 323 patients highlighted that admission to intensive care was required in 22.9% of patients that presented with leakage ( 50 ).…”

Section: Consequences Of Leaksmentioning

confidence: 99%

Colorectal anastomotic leakage: a narrative review of definitions, grading systems, and consequences of leaks

Rennie,

Sharma,

Helwa

2024

Front. Surg.

View full text Add to dashboard Cite

BackgroundAnastomotic leaks (ALs) are a significant and feared postoperative complication, with incidence of up to 30% despite advances in surgical techniques. With implications such as additional interventions, prolonged hospital stays, and hospital readmission, ALs have important impacts at the level of individual patients and healthcare providers, as well as healthcare systems as a whole. Challenges in developing unified definitions and grading systems for leaks have proved problematic, despite acknowledgement that colorectal AL is a critical issue in intestinal surgery with serious consequences. The aim of this study was to construct a narrative review of literature surrounding definitions and grading systems for ALs, and consequences of this postoperative complication.MethodsA literature review was conducted by examining databases including PubMed, Web of Science, OVID Embase, Google Scholar, and Cochrane library databases. Searches were performed with the following keywords: anastomosis, anastomotic leak, colorectal, surgery, grading system, complications, risk factors, and consequences. Publications that were retrieved underwent further assessment to ensure other relevant publications were identified and included.ResultsA universally accepted definition and grading system for ALs continues to be lacking, leading to variability in reported incidence in the literature. Additional factors add to variability in estimates, including differences in the anastomotic site and institutional/individual differences in operative technique. Various groups have worked to publish guidelines for defining and grading AL, with the International Study Group of Rectal Cancer (ISGRC/ISREC) definition the current most recommended universal definition for colorectal AL. The burden of AL on patients, healthcare providers, and hospitals is well documented in evidence from leak consequences, such as increased morbidity and mortality, higher reoperation rates, and increased readmission rates, among others.ConclusionsColorectal AL remains a significant challenge in intestinal surgery, despite medical advancements. Understanding the progress made in defining and grading leaks, as well as the range of negative outcomes that arise from AL, is crucial in improving patient care, reduce surgical mortality, and drive further advancements in earlier detection and treatment of AL.

show abstract

“…Thirty‐day mortality after acute operation is 6.1% and after elective surgery 1.4% 1 . AL in colorectal surgery is usually treated with reoperation, or conservatively by fasting, antibiotics, and draining of abscesses 2,3 …”

Section: Introductionmentioning

confidence: 99%

“…1 AL in colorectal surgery is usually treated with reoperation, or conservatively by fasting, antibiotics, and draining of abscesses. 2,3 Intraluminal covering stents are being used as a nonoperative alternative for the treatment of benign and malignant strictures in the gastrointestinal tract. 4,5 Very recently, covered intraluminal stents have been successfully introduced to manage AL after oesophagectomy, gastric bypass, and gastric sleeve operations.…”

Section: Introductionmentioning

confidence: 99%

Fully covered self‐expandable metal stent placed over a stapled colon anastomosis in an animal model: A pilot study of colon metabolism over the stent

et al. 2022

View full text Add to dashboard Cite

Background and Aim Anastomotic leakage (AL) in colorectal resection and primary anastomosis is a common and feared complication. Fully covered self‐expandable metal stents (FCSEMSs) have been used for the treatment of AL. It is still unknown whether FCSEMSs affect anastomosis healing negatively by causing ischemia. In an animal study, we investigated the metabolic effects over a FCSEMS covering a stapled colon anastomosis. Methods Seven pigs were investigated using microdialysis after laparotomy, colon resection, and anastomosis with stent placement. Measurements were done at the proximal and distal ends of the anastomosis and at a reference catheter placed at the small intestine. Measurements of glucose, pyruvate, lactate, glycerol, and the lactate/pyruvate ratio (L/P) were carried out. Results Lactate and L/P were significantly higher at the oral part of the anastomosis, while glucose showed a small declining tendency. At the distal part of the anastomosis, glucose decreased significantly after the resection but did not reach zero. Lactate increased significantly whereas L/P increased only slightly. Glycerol levels were stable. Conclusion Colon resection caused initially hypermetabolism in the intestinal ends next to the resection site. This hypermetabolism neither deteriorated nor turned into ischemia during the initial postoperative course, but the start of hypoxemia could not be excluded during the study and after the placement of an FCSEMS.

show abstract

Management and 1-year outcomes of anastomotic leakage after elective colorectal surgery

Cited by 6 publications

References 39 publications

The impact of synchronous liver resection on the risk of anastomotic leakage following elective colorectal resection. A propensity score match analysis on behalf of the iCral study group

The impact of synchronous liver resection on the risk of anastomotic leakage following elective colorectal resection. A propensity score match analysis on behalf of the iCral study group

Colorectal anastomotic leakage: a narrative review of definitions, grading systems, and consequences of leaks

Fully covered self‐expandable metal stent placed over a stapled colon anastomosis in an animal model: A pilot study of colon metabolism over the stent

Contact Info

Product

Resources

About