Very Early Colorectal Anastomotic Leakage within 5 Post-operative Days: a More Severe Subtype Needs Relaparatomy

Li, Yi Wei; Lian, Peng; Huang, Ben; Zheng, Hong; Wang, Ming He; Gu, Wei; Li, Xin Xiang; Xu, Ye; Cai, San Jun

doi:10.1038/srep39936

Cited by 38 publications

(42 citation statements)

References 27 publications

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“…8 On the other hand, Yi-Wei Li. 9 Demonstrated risk factors for AL including male sex, high American Society of Anesthesiologists (ASA) fitness grade, emergency surgery, gender is not with statistical significance in our study.…”

Section: Discussioncontrasting

confidence: 65%

Independent perioperative predictive risk factors for the anastomotic leak after emergency bowel resection anastomosis

2019

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Background: Anastomotic disruption after bowel resection anastomosis is a devastating and a feared complication, so it is of utmost importance to identify perioperative parameters predisposing to such complication.Methods: A prospective cohort study was performed in two institutes, and there were 287 patients eligible and included in the study which done from April 2017 to December 2018, 87 patients underwent intervention in the first institute in Zagazig University Hospitals, Egypt. And 200 patients underwent intervention in Riyadh, KSA. Statistical analysis used: Percent of categorical variables were compared using Pearson’s Chi-square test or Fisher's exact test when was appropriate. Risk estimation was done by Odds ratio (OR) calculation. All tests were two sided. A p-value <0.05 was considered significant. All statistics were performed using SPSS 22.0 for Windows (SPSS Inc., Chicago, IL, USA) and MedCalc windows (MedCalc Software bvba 13, Ostend, Belgium).Results: Of the parameters analyzed risk factors for anastomotic leakage that studied in 287 patients, 6 perioperative parameters have significant statistical difference: hypo-albuminaemia (Odd ratio: 6.544 and p-value <0.001), acute intra-abdominal contamination (Odd ratio: 3.921 and P-value <0.004), High WBC'S with high presepsin with p-value <0.001, hyponatremia p<0.004, perioperative blood transfusion and anastomotic tension were found to be independent factors.Conclusions: Knowledge of independent perioperative predictive factors for leakage is of utmost importance for its early detection, decision making for surgical time,our study concluded the possibility to detect a subgroup of high-risk patients for anastomotic leakage after emergency bowel resection anastomosis.

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Section: Discussioncontrasting

confidence: 65%

Independent perioperative predictive risk factors for the anastomotic leak after emergency bowel resection anastomosis

2019

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“…In order to evaluate the postoperative appearance day of fistulas, there were separated three groups, as follows: early appearance of anastomotic leak (1-4 days), median appearance of fistula (5-10 days) and late appearance of anastomotic leakage (>30 days) (7).…”

Section: Resultsmentioning

confidence: 99%

Safety of Anastomoses in Right Hemicolectomy for Colon Cancer

Elöd¹,

Cozlea²,

Neagoe³

et al. 2019

chr

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Introducere: Cancerul colorectal este unul dintre cele mai frecvent întâlnite tumori maligne ale sistemului digestiv, incidenţa acestei boli crude crescând constant. Materiale şi Metode: 236 de pacienţi diagnosticaţi cu cancer de colon drept au fost revizuiţi retrospectiv. Pentru toţi pacienţii incluşi în acest studiu, hemicolectomie dreaptă sau hemicolectomie dreaptă extinsă cu anastomoză ileo-colonică a fost efectuată. Pacienţii au fost împărţiţi în două grupuri: grupul de studiu incluzând pacienţi care au dezvoltat fistulă de anastomoză şi grupul de control, incluzând pacienţi fără fistulă. Date clinice, chirurgicale, postoperatorii şi împrejurările apariţiei fistulelor anastomotice (AL) au fost evaluate. Studiul investighează posibilii factori de risc şi de protecţie pentru dezvoltarea fistulelor anastomotice şi nu în ultimul rând studiează relaţia dintre fistulă de anastomoză şi mortalitatea. Rezultate: factori de risc cum ar fi vârstă înaintată, tumorile 1/3 drepte ale colonului transvers, intervenţiile chirurgicale de urgenţă, sutură mecanică, anastomoza L-T, reluarea tardivă a motilităţii intestinale au fost identificate în timpul cercetării. Anastomoza L-L a fost identificată ca factor protector în dezvoltarea fistulei de anastomoză. Concluzii: Conform rezultatelor cercetării, în cazul tumorilor colonului drept, anastomoza ileo-transversă L-L ar trebui adaptată, având ceea mai scăzută rată în ceea ce priveşte dezvoltarea fistulei de anastomoză.

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“…There were also no clinical changes observed that would suggest development of sepsis or ileus, and the animals managed to maintain their weight; therefore we assume the material does not contribute to postoperative GI obstruction. Most patients develop an anastomotic leakage within the first 2 weeks after the surgery 45,46 , we covered three postoperative weeks of observation. www.nature.com/scientificreports www.nature.com/scientificreports/ Nordentoft et al experimented with fibrin coated collagen patches (TachoSil, fibrin sealant) in a pig model of intestinal anastomosis.…”

Section: Discussionmentioning

confidence: 99%

Experimental fortification of intestinal anastomoses with nanofibrous materials in a large animal model

Rosendorf

Horakova

Klíčová

et al. 2020

Sci Rep

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Anastomotic leakage is a severe complication in gastrointestinal surgery. It is often a reason for reoperation together with intestinal passage blockage due to formation of peritoneal adhesions. Different materials as local prevention of these complications have been studied, none of which are nowadays routinely used in clinical practice. Nanofabrics created proved to promote healing with their structure similar to extracellular matrix. We decided to study their impact on anastomotic healing and formation of peritoneal adhesions. We performed an experiment on 24 piglets. We constructed 3 hand sutured end-to-end anastomoses on the small intestine of each pig. We covered the anastomoses with a sheet of polycaprolactone nanomaterial in the first experimental group, with a sheet of copolymer of polylactic acid with polycaprolactone in the second one and no fortifying material was used in the Control group. The animals were sacrificed after 3 weeks of observation. Clinical, biochemical and macroscopic signs of anastomotic leakage or intestinal obstruction were monitored, the quality of the scar tissue was assessed histologically, and a newly developed scoring system was employed to evaluate the presence of adhesions. The material is easy to manipulate with. There was no mortality or major morbidity in our groups. No statistical difference was found inbetween the groups in the matter of level of peritoneal adhesions or the quality of the anastomoses. We created a new adhesion scoring system. The material appears to be safe however needs to be studied further to prove itsʹ positive effects.

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Very Early Colorectal Anastomotic Leakage within 5 Post-operative Days: a More Severe Subtype Needs Relaparatomy

Cited by 38 publications

References 27 publications

Independent perioperative predictive risk factors for the anastomotic leak after emergency bowel resection anastomosis

Independent perioperative predictive risk factors for the anastomotic leak after emergency bowel resection anastomosis

Safety of Anastomoses in Right Hemicolectomy for Colon Cancer

Experimental fortification of intestinal anastomoses with nanofibrous materials in a large animal model

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