Utility of contrast enema to assess anastomotic integrity and the natural history of radiological leaks after low rectal surgery: systematic review and meta-analysis

Habib, Khalid; Gupta, Ashish; White, Donna L.; Mazari, Fayyaz; Wilson, T. R.

doi:10.1007/s00384-015-2225-7

Cited by 41 publications

(44 citation statements)

References 19 publications

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“…Digital rectal examination is also highly correlated with contrast enema findings (96.7%); therefore, in asymptomatic patients, Habib et al suggested contrast enemas may not be a necessary adjunct to clinical examination in patients with a low uncomplicated anastomosis. 23 Similarly, a single-center retrospective review of 81 patients with low rectal cancer who underwent low anterior resection with diverting stoma reported a 3.7% anastomotic leak rate and a 5.8% subclinical leak rate on contrast enema. Because the overall leak rate is low, the authors argue against the routine use of contrast enema for preoperative evaluation prior to stoma reversal.…”

Section: Contrast Enemamentioning

confidence: 95%

Considerations in Stoma Reversal

Sherman

Wexner

2017

Clinics in Colon and Rectal Surgery

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Temporary stomas are frequently used in the management of diverticulitis, colorectal cancer, and inflammatory bowel disease. These temporary stomas are used to try to mitigate septic complications from anastomotic leaks and to avoid the need for reoperation. Once acute medical conditions have improved and after the anastomosis has been proven to be healed, stomas can be reversed. Contrast enemas, digital rectal examination, and endoscopic evaluation are used to evaluate the anastomosis prior to reversal. Stoma reversal is associated with complications including anastomotic leak, postoperative ileus, bowel obstruction, enterocutaneous fistula, and, most commonly, surgical site infection. Furthermore, many stomas, which were intended to be temporary, may not be reversed due to postoperative complications, adjuvant therapy, or prohibitive comorbidities.

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Section: Contrast Enemamentioning

confidence: 95%

Considerations in Stoma Reversal

Sherman

Wexner

2017

Clinics in Colon and Rectal Surgery

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“…The sensitivity and specificity of contrast enema for clinically significant abnormalities are 79.9 and 95.4%,respectively. 27 Computed tomography (CT) offers the advantage of defining the anatomy to allow for management planning. Intravenous contrast can be very helpful in identifying abscesses, while the utility of oral contrast is debatable, especially with the associated risk of diarrhea from large volume hyperosmotic contrast solutions (►Fig.…”

Section: Diagnosis Of Anastomotic Leakmentioning

confidence: 99%

Management of Colorectal Anastomotic Leak

Thomas

Margolin

2016

Clinics in Colon and Rectal Surgery

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The aim of this article is to present strategies for preventing and managing the failure of the surgical restoration of intestinal continuity. Despite improvements in surgical technique and perioperative care, anastomotic leaks still occur, and with them occur increased morbidity, mortality, length of stay, and costs. Due to the devastating consequences for patients with failed anastomoses, there have been a myriad of materials and techniques used by surgeons to create better intestinal anastomoses. We will also discuss the management strategies for anastomotic leak when they do inevitably occur.

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“…In most cases, ileostomy reversal is postponed [19] and a repeat contrast enema is performed. In 11 cases of persistent leak or sinus formation, only 1 patient developed pelvic sepsis after stoma reversal [31]. In general, bowel function in patients with a postoperative leak is poorer compared to non-leak cases, and the oncological outcome is also impaired [36].…”

Section: Contrast Enemamentioning

confidence: 99%

“…A systematic review on the utility of contrast enema evaluated 1,142 enemas and reported abnormalities in 127 cases, such as leaks, strictures, or fistulas [31]. The sensitivity of the examination Fig.…”

Section: Contrast Enemamentioning

confidence: 99%

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Before and after Anorectal Surgery: Which Information Is Needed from the Functional Laboratory

2018

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Background: Anorectal surgery covers a wide spectrum of surgery. Diagnostic workup of anorectal disease is based on clinical examination with basic functional tests followed by more elaborate diagnostic tests. Since the incidence of anorectal disorders increases with age, more patients will present in outpatient clinics, thus underlining the relevance of this topic. Methods: A PubMed literature search was performed using the terms ‘anal incontinence', ‘anal and rectal surgery', ‘functional diagnostics', and combinations of these terms. No restriction regarding publication year or publication type was applied but randomized trials, ‘metanalyses', or guidelines were ranked higher. Only articles in English or German were included. Results: The diagnostic value of digital rectal examination, anal manometry and endosonography, the water holding procedure, contrast enema, and incontinence scores is summarized. Conclusion: The article focusses on basic clinical and functional diagnostic tests which can be easily applied in the pre- and postoperative setting to evaluate the postoperative outcome.

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Utility of contrast enema to assess anastomotic integrity and the natural history of radiological leaks after low rectal surgery: systematic review and meta-analysis

Cited by 41 publications

References 19 publications

Considerations in Stoma Reversal

Considerations in Stoma Reversal

Management of Colorectal Anastomotic Leak

Before and after Anorectal Surgery: Which Information Is Needed from the Functional Laboratory

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