Risk of clinical leak after laparoscopic versus open bowel anastomosis

El-Gazzaz, Galal; Geisler, Daniel; Hull, Tracy L.

doi:10.1007/s00464-009-0867-7

Cited by 25 publications

(13 citation statements)

References 19 publications

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“…Some studies have identified laparoscopic surgery as a risk factor for anastomotic leakage [14] whereas others have not found any association between the approach and the incidence of anastomotic leakage [23,24]. In this study, incidence of anastomotic leakage was slightly higher in open surgery than in laparoscopic surgery though it did not reach statistical significance.…”

Section: Discussioncontrasting

confidence: 63%

Analysis of Risk Factors and Management of Anastomotic Leakage After Rectal Cancer Surgery: An Indian Series

Jatal

Pai

Demenezes

et al. 2015

Indian J Surg Oncol

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The primary objective of this study was to determine whether sphincter preservation is possible among patients who develop anastomotic leakage after rectal cancer surgery. The secondary objective was to determine the factors that may contribute to anastomotic leakage. This is a retrospective review of a prospectively maintained database. All patients with rectal cancer who underwent restorative proctectomy over 1 year were included in the study. The parameters analyzed were age, preoperative hemoglobin and albumin, neoadjuvant therapy, type of surgery, level of ligation of inferior mesenteric pedicle, technique of anastomosis, and defunctioning proximal stoma. In this study, 176 cases of anterior resection were included,of which15 (8.5 %) had anastomotic leakage. None of the factors contributing to anastomotic leakage reached statistical significance on univariate analysis. Among the patients who had proximal defunctioning ileostomy (n = 9), five (56 %) required re-surgery whereas other four were managed with antibiotics and presacral drainage alone (44 %). Among the patients who didnot have proximal defunctioning ileostomy (n = 6), all (100 %) required re-surgery. Among the 12 eligible patients, stoma reversal was successful in eight (67 %) patients. This study highlights the importance of defunctioning proximal stoma in reducing the incidence and severity of anastomotic leakage as well as the need and extent of re-surgery for low rectal cancer. Sphincter preservation is possible in majority of patients who develop anastomotic leakage after rectal cancer surgery.

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Section: Discussioncontrasting

confidence: 63%

Analysis of Risk Factors and Management of Anastomotic Leakage After Rectal Cancer Surgery: An Indian Series

Jatal

Pai

Demenezes

et al. 2015

Indian J Surg Oncol

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“…Nine studies [16,21,27,29,32,37,38,40],[42] included patients with any bowel resection. These resections included ileocecal resection, other small bowel resections, segmental colectomy and subtotal colectomy.…”

Section: Resultsmentioning

confidence: 99%

Laparoscopic surgery for Crohn’s disease: a meta-analysis of perioperative complications and long term outcomes compared with open surgery

Patel

Ramagopalan

et al. 2013

BMC Surg

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BackgroundPrevious meta-analyses have had conflicting conclusions regarding the differences between laparoscopic and open techniques in patients with Crohn’s Disease. The objective of this meta-analysis was to compare outcomes in patients with Crohn’s disease undergoing laparoscopic or open surgical resection.MethodsA literature search of EMBASE, MEDLINE, The Cochrane Central Register of Controlled Trials and the US National Institute of Health’s Clinical Trials Registry was completed. Randomized clinical trials and non-randomized comparative studies were included if laparoscopic and open surgical resections were compared. Primary outcomes assessed included perioperative complications, recurrence requiring surgery, small bowel obstruction and incisional hernia.Results34 studies were included in the analysis, and represented 2,519 patients. Pooled analysis showed reduced perioperative complications in patients undergoing laparoscopic resection vs. open resection (Risk Ratio 0.71, 95% CI 0.58 – 0.86, P = 0.001). There was no evidence of a difference in the rate of surgical recurrence (Rate Ratio 0.78, 95% CI 0.54 – 1.11, P = 0.17) or small bowel obstruction (Rate Ratio 0.63, 95% CI 0.28 – 1.45, P = 0.28) between techniques. There was evidence of a decrease in incisional hernia following laparoscopic surgery (Rate Ratio 0.24, 95% CI 0.07 – 0.82, P = 0.02).ConclusionsThis is the largest review in this topic. The results of this analysis are based primarily on non-randomized studies and thus have significant limitations in regards to selection bias, confounding, lack of blinding and potential publication bias. Although we found evidence of decreased perioperative complications and incisional hernia in the laparoscopic group, further randomized controlled trials, with adequate follow up, are needed before strong recommendations can be made.

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“…Accordingly, while our results do not bear statistical significance, we believe the clinical results to be well worth further investigation on a large, multicenter scale. The incidence of surgical site infection following colorectal cancer operation reportedly ranges from 10 to 30 %, and the incidences of anastomotic leakage are 3-6 % in colon cancer and 3-15 % in rectal cancer [17][18][19][20][21][22]. Despite declining rates of occurrence due to advances in the operative procedures and equipment, these complications are not rare [23].…”

Section: Discussionmentioning

confidence: 95%

A clinical trial of autologous adipose-derived regenerative cell transplantation for a postoperative enterocutaneous fistula

et al. 2015

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Risk of clinical leak after laparoscopic versus open bowel anastomosis

Abstract: A laparoscopic colorectal approach is not associated with a higher risk of clinical anastomotic bowel leak.

Cited by 25 publications

References 19 publications

Analysis of Risk Factors and Management of Anastomotic Leakage After Rectal Cancer Surgery: An Indian Series

Analysis of Risk Factors and Management of Anastomotic Leakage After Rectal Cancer Surgery: An Indian Series

Laparoscopic surgery for Crohn’s disease: a meta-analysis of perioperative complications and long term outcomes compared with open surgery

A clinical trial of autologous adipose-derived regenerative cell transplantation for a postoperative enterocutaneous fistula

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