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

Daams, Freek; Slieker, Juliette; Tedja, A.; Karsten, Thomas; Lange, Johan F.

doi:10.1159/000346348

Cited by 17 publications

(24 citation statements)

References 29 publications

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“…In addition, the management of those diagnosed with anastomotic dehiscence is likely to have changed with an increase in nonoperative strategies to treat those with smaller leaks. 15 In addition, the proportion of patients treated by a specialist colorectal surgeon increased from 13.8% to 67.6% (P < 0.001). 2 This increase in specialist surgery contributed significantly to improvements in longer term survival and the overall reduction in anastomotic leakage over this period.…”

Section: Discussionmentioning

confidence: 95%

“…This suggests that patient selection and surgical techniques have improved leading to fewer anastomotic leaks. In addition, the management of those diagnosed with anastomotic dehiscence is likely to have changed with an increase in nonoperative strategies to treat those with smaller leaks . In addition, the proportion of patients treated by a specialist colorectal surgeon increased from 13.8% to 67.6% ( P < 0.001) .…”

Section: Discussionmentioning

confidence: 99%

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Validation of a modified clinical risk score to predict cancer‐specific survival for stage II colon cancer

et al. 2014

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Many patients with stage II colon cancer will die of their disease despite curative surgery. Therefore, identification of patients at high risk of poor outcome after surgery for stage II colon cancer is desirable. This study aims to validate a clinical risk score to predict cancer-specific survival in patients undergoing surgery for stage II colon cancer. Patients undergoing surgery for stage II colon cancer in 16 hospitals in the West of Scotland between 2001 and 2004 were identified from a prospectively maintained regional clinical audit database. Overall and cancer-specific survival rates up to 5 years were calculated. A total of 871 patients were included. At 5 years, cancer-specific survival was 81.9% and overall survival was 65.6%. On multivariate analysis, age ≥75 years (hazard ratio (HR) 2.11, 95% confidence intervals (CI) 1.57–2.85; P<0.001) and emergency presentation (HR 1.97, 95% CI 1.43–2.70; P<0.001) were independently associated with cancer-specific survival. Age and mode of presentation HRs were added to form a clinical risk score of 0–2. The cancer-specific survival at 5 years for patients with a cumulative score 0 was 88.7%, 1 was 78.2% and 2 was 65.9%. These results validate a modified simple clinical risk score for patients undergoing surgery for stage II colon cancer. The combination of these two universally documented clinical factors provides a solid foundation for the examination of the impact of additional clinicopathological and treatment factors on overall and cancer-specific survival.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Validation of a modified clinical risk score to predict cancer‐specific survival for stage II colon cancer

et al. 2014

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“…The treatment options include one or more of antibiotic therapy, transanal drainage, percutaneous drainage, laparoscopy/laparotomy with anastomotic repair and defunctioning stoma, and take‐down of the anastomosis with end‐stoma. A survey of 350 members of the Dutch Society of Gastrointestinal Surgery suggested heterogeneity in the strategies employed to manage leakage with a preference to try and preserve a left‐sided anastomosis in more fit and younger patients .…”

Section: Management Strategies For Anastomotic Leakagementioning

confidence: 99%

A collaborative review of the current concepts and challenges of anastomotic leaks in colorectal surgery

et al. 2017

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The reduction of the incidence, detection and treatment of anastomotic leakage (AL) continues to challenge the colorectal surgical community. AL is not consistently defined and reported in clinical studies, its occurrence is variably reported and its impact on longterm morbidity and health-care resources has received relatively little attention. Controversy continues regarding the best strategies to reduce the risk. Diagnostic tests lack sensitivity and specificity, resulting in delayed diagnosis and increased morbidity. Intra-operative fluorescence angiography has recently been introduced as a means of real-time assessment of anastomotic perfusion and preliminary evidence suggests that it may reduce the rate of AL. In addition, concepts are emerging about the role of the rectal mucosal microbiome in AL and the possible role of new prophylactic therapies. In January 2016 a meeting of expert colorectal surgeons and pathologists was held in London, UK, to identify the ongoing controversies surrounding AL in colorectal surgery. The outcome of the meeting is presented in the form of research challenges that need to be addressed.

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“…For late bowel perforations, it was assumed that 70% of patients undergo a colostomy procedure and the remaining 30% undergo a laparascopic resuturing procedure. 40,41…”

Section: Methodsmentioning

confidence: 99%

Potential Value of Haptic Feedback in Minimally Invasive Surgery for Deep Endometriosis

Vlek¹,

Burm²,

Govers³

et al. 2020

Surg Innov

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Introduction. Laparoscopic treatment of deep endometriosis (DE) is associated with intra- and post-operative morbidity. New technological developments, such as haptic feedback in laparoscopic instruments, could reduce the rate of complications. The aim of this study was to assess the room for improvement and potential cost-effectiveness of haptic feedback instruments in laparoscopic surgery. Methods. To assess the potential value of haptic feedback, a decision analytical model was constructed. Complications that could be related to the absence of haptic feedback were included in the model. Costs of complications were based on the additional length of hospital stay, operating time, outpatient visits, reinterventions, and/or conversions to laparotomy. The target population consists of women who are treated for DE in the Netherlands. A headroom analysis was performed to estimate the maximum value of haptic feedback in case it would be able to prevent all selected intra- and post-operative complications. Results. A total of 9.7 intraoperative and 47.0 post-operative complications are expected in the cohort of 636 patients annually treated for DE in the Netherlands. Together, these complications cause an additional length of hospital stay of 432.1 days, 10.2 additional outpatient visits, 73.9 reinterventions, and 4.2 conversions. Most consequences are related to post-operative complications. The total additional annual costs due to complications were €436 623, amounting to €687 additional costs per patient. Discussion. This study demonstrated that the potential value for improvement in DE laparoscopic surgery by using haptic feedback instruments is considerable, mostly caused by the potential prevention of major post-operative complications.

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

Cited by 17 publications

References 29 publications

Validation of a modified clinical risk score to predict cancer‐specific survival for stage II colon cancer

Validation of a modified clinical risk score to predict cancer‐specific survival for stage II colon cancer

A collaborative review of the current concepts and challenges of anastomotic leaks in colorectal surgery

Potential Value of Haptic Feedback in Minimally Invasive Surgery for Deep Endometriosis

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