Surgical Re-interventions Following Colorectal Surgery: Open Versus Laparoscopic Management of Anastomotic Leakage

2013 ◽  
Vol 23 (9) ◽  
pp. 739-744 ◽  
Author(s):  
Sandra Vennix ◽  
Raoul Abegg ◽  
Olaf J. Bakker ◽  
Peter B. van den Boezem ◽  
Walter J.A. Brokelman ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Anastomotic Leakage ◽  
Laparoscopic Management ◽  
Open Versus

scholarly journals Early postoperative pain as a marker of anastomotic leakage in colorectal cancer surgery

2021 ◽  
Author(s):  
Petrus Boström ◽  
Johan Svensson ◽  
Camilla Brorsson ◽  
Martin Rutegård
Keyword(s):  
Colorectal Cancer ◽  
Postoperative Pain ◽  
Colorectal Surgery ◽  
Anastomotic Leakage ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Population Based ◽  
Colorectal Cancer Surgery ◽  
Increased Risk ◽  
Independent Marker

Abstract Purpose Even though anastomotic leakage after colorectal surgery is a major clinical problem in need of a timely diagnosis, early indicators of leakage have been insufficiently studied. We therefore conducted a population-based observational study to determine whether the patient’s early postoperative pain is an independent marker of anastomotic leakage. Methods By combining the Swedish Colorectal Cancer Registry and the Swedish Perioperative Registry, we retrieved prospectively collected data on 3084 patients who underwent anastomotic colorectal surgery for cancer in 2014–2017. Postoperative pain, measured with the numerical rating scale (NRS), was considered exposure, while anastomotic leakage and reoperation due to leakage were outcomes. We performed logistic regression to evaluate associations, estimating odds ratios (ORs) and 95% confidence intervals (CIs), while multiple imputation was used to handle missing data. Results In total, 189 patients suffered from anastomotic leakage, of whom 121 patients also needed a reoperation due to leakage. Moderate or severe postoperative pain (NRS 4–10) was associated with an increased risk of anastomotic leakage (OR 1.69, 95% CI 1.21–2.38), as well as reoperation (OR 2.17, 95% CI 1.41–3.32). Severe pain (NRS 8–10) was more strongly related to leakage (OR 2.38, 95% CI 1.44–3.93). These associations were confirmed in multivariable analyses and when reoperation due to leakage was used as an outcome. Conclusion In this population-based retrospective study on prospectively collected data, increased pain in the post-anaesthesia care unit is an independent marker of anastomotic leakage, possibly indicating a need for further diagnostic measures.

scholarly journals Markers of Perioperative Bowel Complications in Colorectal Surgery Patients

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Radomír Hyšpler ◽  
Alena Tichá ◽  
Milan Kaška ◽  
Lenka Žaloudková ◽  
Lenka Plíšková ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Anastomotic Leakage ◽  
Intestinal Resection ◽  
Specific Marker ◽  
Exhaled Breath ◽  
Fatty Acid Binding ◽  
Gastrointestinal Complications ◽  
Reactive Protein ◽  
The Difference ◽  
Low Sensitivity

Colorectal cancer is a clinical condition whose treatment often involves intestinal resection. Such treatment frequently results in two major gastrointestinal complications after surgery: anastomotic leakage and prolonged ileus. Anastomotic leakage is a serious complication which, more often than not, is diagnosed late; to date, C-reactive protein is the only available diagnostic marker. A monocentric, prospective, open case-control study was performed in patients(n=117)undergoing colorectal surgery. Intestinal fatty acid binding protein (i-FABP), citrulline, D-lactate, exhaled hydrogen,Escherichia coligenomic DNA, and ischemia modified albumin (IMA) were determined preoperatively, postoperatively, and on the following four consecutive days. Bacterial DNA was not detected in any sample, and i-FABP and D-lactate lacked any distinct potential to detect postoperative bowel complications. Exhaled breath hydrogen content showed unacceptably low sensitivity. However, citrulline turned out to be a specific marker for prolonged ileus on postoperative days 3-4. Using a cut-off value of 20 μmol/L, a sensitivity and specificity of ~75% was achieved on postoperative day 4. IMA was found to be an efficient predictor of anastomosis leak by calculating the difference between preoperative and postoperative values. This test had 100% sensitivity and 80% specificity and 100% negative and 20% positive predictive value.

Monitoring of procalcitonin but not interleukin-6 is useful for the early prediction of anastomotic leakage after colorectal surgery

2017 ◽  
Vol 55 (7) ◽  
Author(s):  
Urszula Zielińska-Borkowska ◽  
Naser Dib ◽  
Wiesław Tarnowski ◽  
Tomasz Skirecki
Keyword(s):  
Colorectal Surgery ◽  
Anastomotic Leakage ◽  
Interleukin 6 ◽  
Early Recognition ◽  
Surgical Trauma ◽  
Serum Samples ◽  
Elective Colorectal Surgery ◽  
Surgical Infections ◽  
Bowel Diseases ◽  
The Difference

AbstractBackground:Early recognition of patients who have developed anastomotic leakage (AL) after colorectal surgery is crucial for the successful treatment of this complication. The aim of this study was to assess the usefulness of the assessment of procalcitonin (PCT) and interleukin-6 (IL-6) levels in the prognosis of AL.Methods:This observational study included 157 patients who underwent major elective colorectal surgery. The most common indications for surgery were cancer and inflammatory bowel diseases. Serum samples were obtained directly before surgery (D0) and 1 day (D1) after surgery, and the relationships between the serum concentrations of PCT and IL-6 and development of AL were assessed.Results:In total, 10.2% of patients developed post-surgical infections due to AL. PCT levels on D1 were significantly higher in patients who developed AL [2.73 (1.40–4.62)] than in those who recovered without complications [0.2 (0.09–0.44)]. The area under the ROC curve for PCT on D1 was 0.94, 95% CI (0.89–0.98). The sensitivity and specificity of the prediction of an infection were 87% and 87%, respectively, for PCT on D1, which was higher than 1.09 ng/mL. The increase in PCT concentration between D0 and D1 was significantly higher in patients with AL (p<0.001). Patients who developed AL had higher concentrations of IL-6 on D1, but the difference was not significant (p=0.28).Conclusions:This study confirms that surgical trauma increases serum PCT concentrations and that the concentration of PCT on D1 can predict AL after colorectal surgery. However, IL-6 is not a good early marker for developing AL.

How to reduce anastomotic leakage in colorectal surgery—report from German expert meeting

2020 ◽  
Vol 405 (2) ◽  
pp. 223-232
Author(s):  
Andreas D. Rink ◽  
Peter Kienle ◽  
Felix Aigner ◽  
Alexis Ulrich
Keyword(s):  
Colorectal Surgery ◽  
Anastomotic Leakage ◽  
German Expert ◽  
Expert Meeting

Diagnostic accuracy of procalcitonin for the early diagnosis of anastomotic leakage after colorectal surgery: a meta‐analysis

2019 ◽  
Vol 90 (5) ◽  
pp. 675-680
Author(s):  
Bruce Su'a ◽  
Senitila Tutone ◽  
Wiremu MacFater ◽  
Ahmed Barazanchi ◽  
Weisi Xia ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Early Diagnosis ◽  
Diagnostic Accuracy ◽  
Anastomotic Leakage ◽  
Meta Analysis
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