DOI: http://dx.doi.org/10.18203/2349-2902.isj20191051

Early detection of anastomotic leakage after hand-sewn colorectal anastomoses

Ayman A. Albatanony, Mahmoud A. Shahin, Mohamed M. Balpoush

Abstract


Background: Colorectal anastomotic leakage is a serious complication leading to major postoperative morbidity and mortality. In the present study, author investigated the early detection of anastomotic leakage before its clinical presentation.

Methods: This prospective study was including 80 consecutive patients with colorectal anastomoses using hand sewn technique. Patients follow-up was done to detect postoperative leak, study variables included hospital stay, wound infection, postoperative daily C-reactive protein, parameters of DULK-score and microbiological study of peritoneal fluid.

Results: Clinically evident AL occurred in twelve patients (15%) and diagnosed postoperatively on median day 6. The median interval between appearance of the initial signs of clinical deterioration and the confirmation of AL was three days using DULK-score. C-reactive protein was significantly higher in patients with leakage with a cut-off value of 120 mg/l on 3rd postoperative day. Intraperitoneal bacterial colonization was significantly higher in patients with clinical evidence of AL (p value 0.012). Wound infection was significantly higher in anastomotic leakage group (p value 0.001). The hospital stay for the patients with anastomotic leakage was significantly longer than those without AL (p value 0.001).

Conclusions: Routine application of DULK-score leads to diagnosis of AL three days earlier. C-reactive protein is a simple way to ensure a safe discharge from hospital after colorectal surgery.

 


Keywords


Anastomotic leakage, Bacterial colonization, Colon leakage score, C-reactive protein, DULK scores

Full Text:

PDF

References


Komen N, Morsink MC, Beiboer S, Miggelbrink A, Willemsen P, et al. Detection of colon flora in peritoneal drain fluid after colorectal surgery: can RT-PCR play a role in diagnosing anastomotic leakage? J Microbiol Methods. 2009;79(1):67-70.

Hyman NH. Managing anastomotic leaks from intestinal anastomoses. Surg J Royal Coll Surg Edinburgh Ireland. 2009;7(1):31-5.

Dekker JW, Liefers GJ, Otterloo JC, Putter H, Tollenaar RA. Predicting the risk of anastomotic leakage in left-sided colorectal surgery using a colon leakage score. J Surg Res. 2011;166(1):27-34.

Dulk M, Noter SL, Hendriks ER, Brouwers MA, Vlies CH, Oostenbroek RJ, et al. Improved diagnosis and treatment of anastomotic leakage after colorectal surgery. Euro J Surg Oncol. 2009;35(4):420-6.

Chylak J, Michalska W, Drews M, Marciniak R, Lange M. Comparison of bacterial flora found in the peritoneal cavity and drains after intraabdominal surgery. Med Sci Monitor. 2000;6(2):285-90.

Almeida AB, Faria G, Moreira H, Pinto-de-Sousa J, Correia-da-Silva P, Maia JC. Elevated serum C-reactive protein as a predictive factor for anastomotic leakage in colorectal surgery. Inter J Surg. 2012;10(2):87-91.

Garcia-Granero A, Frasson M, Flor-Lorente B, Blanco F, Puga R, Carratalá A, et al. Procalcitonin and C-reactive protein as early predictors of anastomotic leak in colorectal surgery: a prospective observational study. Dis Colon Rectum. 2013;56(4):475-83.

Toutouzas K, Kleidi ES, Drimousis PG, Balla M, Papanikolaou MN, Larentzakis A, et al. Anastomotic leak management after a low anterior resection leading to recurrent abdominal compartment syndrome: a case report and review of the literature. J Med Case Rep. 2009;3(1):125.

Buchs NC, Gervaz P, Secic M, Bucher P, Mugnier-Konrad B, et al. Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study. Inter J Colorectal Dis. 2008;23(3):265-70.

Konishi T, Watanabe T, Kishimoto J, Nagawa H. Risk factors for anastomotic leakage after surgery for colorectal cancer: results of prospective surveillance. J Am Coll Surg. 2006;202:439–44.

Asteria CR, Gagliardi G, Pucciarelli S, Romano G, Infantino A, La Torre F, et al. Anastomotic leaks after anterior resection for mid and low rectal cancer: survey of the Italian Society of Colorectal Surgery. Tech Coloproctol. 2008;12(2):103-10.

Jung SH, Yu CS, Choi PW, Kim DD, Park IJ, Kim HC, et al. Risk factors and oncologic impact of anastomotic leakage after rectal cancer surgery. Dis Colon Rectum. 2008;51(6):902.

Kingham TP, Pachter HL. Colonic anastomotic leak: risk factors, diagnosis, and treatment. J Am Coll Surg. 2009;208(2):269-78.

Branagan G, Finnis D. Prognosis after anastomotic leakage in colorectal surgery. Dis Colon Rectum. 2005;48(5):1021-6.

Lipska MA, Bissett IP, Parry BR, Merrie AE. Anastomotic leakage after lower gastrointestinal anastomosis: men are at a higher risk. ANZ J Surg. 2006;76(7):579-85.

Choi DH, Hwang JK, Ko YT, Jang HJ, Shin HK, Lee YC, et al. Risk factors for anastomotic leakage after laparoscopic rectal resection. J Korean Soc Coloproctol. 2010;26(4):265.

Choi HK, Law WL, Ho JW. Leakage after resection and intraperitoneal anastomosis for colorectal malignancy: analysis of risk factors. Dis Colon Rectum. 2006;49(11):1719-25.

Martin G, Dupré A, Mulliez A, Prunel F, Slim K, Pezet D. Validation of a score for the early diagnosis of anastomotic leakage following elective colorectal surgery. J Visc Surg. 2015;152(1):5-10.

Warschkow R, Beutner U, Steffen T, Müller SA, Schmied BM, Güller U, et al. Safe and early discharge after colorectal surgery due to C-reactive protein: a diagnostic meta-analysis of 1832 patients. Ann Surg. 2012;256(2):245-50.

Platt JJ, Ramanathan ML, Crosbie RA, Anderson JH, McKee RF, Horgan PG, et al. C-reactive protein as a predictor of postoperative infective complications after curative resection in patients with colorectal cancer. Ann Surg Oncol. 2012;19(13):4168-77.

Ortega-Deballon P, Radais F, Facy O, d’Athis P, Masson D, Charles PE, et al. C-reactive protein is an early predictor of septic complications after elective colorectal surgery. World J Surg. 2010;34(4):808-14.

Singh PP, Zeng IS, Srinivasa S, Lemanu DP, Connolly AB, Hill AG. Systematic review and meta‐analysis of use of serum C‐reactive protein levels to predict anastomotic leak after colorectal surgery. Brit J Surg. 2014;101(4):339-46.

Fernández MR, Ruiz FR, López AF, Segurola CL, Cebrián JM, de Juan FD. C-reactive protein as a predictor of anastomotic leakage in colorectal surgery: comparison between open and laparoscopic surgery. Cirug Esp. 2017;95(9):529-35.