Management and outcome of colorectal anastomotic leaks

Thornton, Michael; Joshi, Heman; Vimalachandran, C.D.; Heath, Richard M.; Carter, Paul; Gur, Ufuk; Rooney, Paul

doi:10.1007/s00384-010-1094-3

Cited by 86 publications

(56 citation statements)

References 35 publications

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“…Anastomotic leakage is a serious complication after gastrointestinal surgery resulting in a significant increase in the 30-day mortality and morbidity rates. The mortality rate of this complication may be as high as 13-27% [1,2,3,4,5,6,7,8]. The reported anastomotic leakage rates are 1-39%, but a comparative evaluation of the studies is difficult due to the lack of standardized definitions [9,10,11].…”

Section: Introductionmentioning

confidence: 99%

Fibrin Glue Does Not Improve Healing of Gastrointestinal Anastomoses: A Systematic Review

et al. 2014

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Background/Aim: Anastomotic leakage remains a frequent and serious complication in gastrointestinal surgery. In order to reduce its incidence, several clinical and experimental studies on anastomotic sealing have been performed. In a number of these studies, the sealing material has been fibrin glue (FG), and the results in individual studies have been varying. The positive effect of anastomotic sealing with FG might be due to the mechanical/physical properties, the increased healing of the anastomoses or both. The aim of this systematic review was to evaluate the existing evidence on the healing effects of FG on gastrointestinal anastomoses. Methods: PubMed, EMBASE and the Cochrane databases were searched for studies evaluating the healing process of gastrointestinal anastomoses after any kind of FG application. The search period was from 1953 to December 2013. Results: Twenty-eight studies were included in the qualitative synthesis. These studies were all experimental studies, since no human studies used histological or biochemical evaluation of healing. In 7 of the 28 studies, a positive effect of FG on healing was found, while 8 studies reported a negative effect and 11 studies found no effect. Furthermore, 2 studies reported unclear results. The difference in the study outcome was independent of the study design and the type of FG used. Conclusion: In the available studies, FG did not consistently have a positive influence on the healing of gastrointestinal anastomoses. It is consequently plausible that the positive effect of FG sealing of gastrointestinal anastomoses, if there is any, may be due to a mechanical sealing effect rather than due to improved healing per se.

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Section: Introductionmentioning

confidence: 99%

Fibrin Glue Does Not Improve Healing of Gastrointestinal Anastomoses: A Systematic Review

et al. 2014

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“…Anastomotic leakage may cause peritonitis or intra-abdominal abscesses. They may increase morbidity, mortality and the duration of hospitalization [13].…”

Section: Discussionmentioning

confidence: 99%

The Effects of Early Enteral Nutrition Products on the Healing of Colo-Colonic Anastomosis

Şit¹,

İlgün²,

Çatal³

et al. 2015

Adv Clin Exp Med

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Objectives. Complications after colorectal surgery have not been reduced in recent years. Anastomotic leakage is responsible for nearly all morbidity in colonic surgery and for about one third of the mortality. Material and Methods. For the study, 34 albino Wistar rats (about 155-190 g in weight) were divided into four experimental groups. Each of the rats underwent an abdominal incision and resection of the colon 4 cm distal to the cecum to form a colo-colonic anastomosis. In the post-operative period, the first group (n = 8) were fed with standard rat food and water, the second group (n = 9) with dextrose + Ringer solution, the third group (n = 9) with Biosorb ® (Nutricia, Zoetermeer, The Netherlands), and the fourth group (n = 8) with Impact ® (Novartis Nutrition, USA). Results. The blow-out pressure of the anastomoses was significantly different in the group fed 5% dextrose + + Ringer solution group than in the Biosorb ® and Impact ® groups. Conclusions. None of the various nutrients investigated in the present study were significantly superior to standard foods in terms of the blow-out pressures. On the other hand, immunonutrients were more beneficial effects than other nutrients in terms of the healing of colonic anastomoses and post-operative weight loss (Adv Clin Exp Med 2015, 24, 3, 463-467).

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confidence: 99%

“…1,6 In addition to existing interventions used to decrease the risk of anastomotic leakage, such as altered surgical techniques, preoperative optimization, and different postoperative regimens, anastomotic coating has been suggested as a potential method. 7 Numerous experimental studies evaluating anastomotic coating have reported positive effects; however, contradictory results were found when the same coating material was evaluated by other researchers or in a different study design.…”

mentioning

confidence: 99%

Decreased Leakage Rate of Colonic Anastomoses by Tachosil Coating: An Experimental Study

Pommergaard

Achiam

Burcharth

et al. 2014

International Surgery

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Colorectal anastomotic coating has been proposed as a means to lower the leakage rate. Prior to clinical testing, coating materials need thorough experimental evaluation to ensure safety and efficacy. The aim of this study was to evaluate Tachosil as an anastomotic coating agent. Technically insufficient colon anastomoses were created in 80 C57BL/6 mice, and in half of the animals the anastomoses were covered with Tachosil. The animals were examined for clinical signs of anastomotic leakage, and the breaking strength of the anastomoses was evaluated. The number of leakages was reduced by Tachosil coating (10/40 versus 20/40 in controls; P ¼ 0.037). However, more cases of large bowel obstruction were found in the Tachosil group (12/40 versus 0/40 in controls; P , 0.0005). Breaking strength was comparable between the Tachosil and control groups (0.49 N versus 0.52 N, respectively; P ¼ 0.423). Clinical studies are needed to clarify the efficacy of Tachosil anastomotic coating.Key words: Colon anastomotic leakage -Anastomotic dehiscence -Anastomotic failureAnimal model -Experimental -Coating -Tachosil -Sealing A nastomotic leakage remains a feared and frequent complication in gastrointestinal surgery, especially for anastomoses on the colon and rectum, with leakage rates of 3% to 7% and 13%, respectively, 1-5 leading to a mortality rate of up to 27%. 1,6 In addition to existing interventions used to decrease the risk of anastomotic leakage, such as altered surgical techniques, preoperative optimization, and different postoperative regimens, anastomotic coating has been suggested as a potential method.7 Numerous experimental studies evaluating anastomotic coating have reported positive effects; however, contradictory results were found when the same coating material was evaluated by other researchers or in a different study design. Furthermore, a few coating materials have been evaluated in humans, but without convincing 7 In order to establish a rationale for conducting large, clinical, randomized, controlled trials in which specific coating agents are evaluated, positive results have to be reproduced in several animal studies to ensure the safety and efficacy of the materials and methods. Tachosil (Hakeda, Osaka, Japan) has been evaluated in a technically insufficient anastomosis in a mouse model by Pantelis et al. 8 This study reported the positive result that Tachosil reduced the anastomotic leakage rate from 36.7% to 5.9%. These results, together with the findings of other studies, 9,10 suggest that Tachosil is one of the most promising agents for colorectal anastomotic coating.The aim of this study was to evaluate the use of Tachosil to lower the anastomotic leakage rate in a mouse model of the technically insufficient colon anastomosis. Furthermore, we aimed to investigate if the results produced by Pantelis et al 8 were reproducible in our setting. Materials and MethodsEnd-to-end colonic anastomoses were created in 80 male C57BL/6 mice (23-30 g). The animals were anesthetized with isoflurane (isoflurane, 2%...

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Management and outcome of colorectal anastomotic leaks

Cited by 86 publications

References 35 publications

Fibrin Glue Does Not Improve Healing of Gastrointestinal Anastomoses: A Systematic Review

Fibrin Glue Does Not Improve Healing of Gastrointestinal Anastomoses: A Systematic Review

The Effects of Early Enteral Nutrition Products on the Healing of Colo-Colonic Anastomosis

Decreased Leakage Rate of Colonic Anastomoses by Tachosil Coating: An Experimental Study

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