Early diagnosis of anastomotic dehiscence after colonic surgery

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Published Feb 7, 2011
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Vol. 89 No. 2 (2011): Issue Feb 2011

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Brahim Ghariani
Hichem Houissa
Farouk Sebai

Abstract

Background: Anastomotic leaks are often responsible for severe sepsis can lead to death. Rapid diagnosis and early intervention are needed to improve prognosis.
Aim: To identify predictors of early diagnosis of anastomotic leakage after colonic resection followed by immediate anastomosis without protective stoma to ensure a rapid therapeutic care and improve prognosis.
Methods: This retrospective study involved patients who had a colonic resection over a period from 1st January 1998 to December 31th, 2009. The diagnosis of anastomotic dehiscence was selected on clinical, radiological and / or surgery. Statistical analysis was undertaken to identify clinical and biological changes leading to early diagnosis. The significance level was set at 0.05.
Results: Anastomotic leaks were identified in 28 patients, a rate of 8.9%. Revision surgery was indicated in 23 patients. Univariate analysis identified 3 preoperative factors associated with anastomotic dehiscence (ASA score, the urgency of intervention, and neoplastic etiology), and 5 postoperative factors (parietal complications, respiratory problems, the cardiac disorders, neurological disorders, and bloating). Multivariate analysis identified only three factors
related to the anastomotic dehiscence, they were respiratory symptoms, bloating, and neurological disorders. The median length of stay was 15.6 days (5-84). The mortality rate was 1.2%. It was higher in patients with leakage (7.4%) than in patients withou leakage (0.7%).
Conclusion: Better knowledge of these early clinical and laboratory manifestations related to anastomotic leaks, can ask the early indication of a radiological drainage or reoperation, which can improve the prognosis of this dreaded disease.

Keywords:

Surgery, colon, anastomotic dehiscence, diagnosis, prognosis

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References

  1. Alves A, Panis Y, Trancart D et al. Factors associated with clinically significant anastomotic leakage after large bowel resection: multivariate analysis of 707 patients. World J Surg 2002; 26: 499-502
  2. Koperna T. Cost-effectiveness of defunctioning stomas in low anterior resection for rectal cancer. Arch Surg 2003; 138:1334-38.
  3. Bruce J, Krukowski ZH, Al-Khairy G et al. Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg 2001; 88:1157-68.
  4. Matthiessen P, Hallbook O, Andersson M et al. Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis 2004; 6:462-69.
  5. Alves A, Panis Y, Pocard M et al. Management of anastomotic leakage after nondiverted large bowel resection. J Am Coll Surg 1999; 189:554-59.
  6. Mileski WJ, Joehl RJ, Rege RV, et al. Treatment of anastomotic leakage following low anterior colon resection. Arch Surg 1988; 123: 968-71.
  7. Vignali A, Fazio VW, Lavery IC,et al. Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1014 patients. J Am Coll Surg 1997; 185:105-13.
  8. Fingerhut A,Hay JM,El hadad A,et al. Supra peritoneal colorectal anastomosis: hand-sewn versus circular staples—a controlled clinical trial. Surgery 1995; 118: 479-85.
  9. Merad F, Yahchouchi E, Hay JM, et al. Prophylactic abdominal Drainage after elective resection and supra promontory anastomosis. A multicenter study controlled by randomization. Arch Surg 1998; 133: 309-14.
  10. Lipska MA, Bissett IP, Parry BR et al. Anastomotic leakage after lower gastrointestinal anastomosis: men are at higher risk. A N Z J Surg 2006; 76:579-585
  11. Platell C, Barwood N, Dorfmann G et al. The incidence of anastomotic leaks in patients undergoing colorectal surgery. Colorectal Dis 2006; 9:71-79.
  12. Bruce J, Russell EM, Mollison J et al The measurement and monitoring of surgical adverse events. Health Technol Assess 2001; 5:1-194
  13. Golub R, Golub RW, Cantu R Jr et al. A multivariate analysis of factors contributing to leakage of intestinal anastomoses. J Am Coll Surg 1997; 184:364-72
  14. Biondo S, Pares D, Kreisler E et al Anastomotic dehiscence after resection and primary anastomosis in left-sided colonic emergencies. Dis Colon Rectum.2005; 48: 2272-80
  15. Mac Arthur DC, Nixon SJ, Aitken RJ. Avoidable deaths still occur after large bowel surgery. Br J Surg 1998; 85: 80-83.
  16. Fielding LP, Stewart-Brown S, Blesovsky L, Kearney G. Anastomotic integrity after operations for large-bowel cancer: a multicentre study. Br Med J 1980; 281: 411-14.
  17. Frileux P, Quilichini MA, Cugnenc PH, et al. Péritonites post opératoires d'origine colique. Ann Chir 1985; 39: 649-59.
  18. Shorthouse AJ, Bartram CI, Eyers AA, Thompson JPS. The watersoluble contrast enema after rectal anastomosis. Br J Surg 1982; 69: 714-17.
  19. Lavery IC. Colonic fistula. Surg Clin North Am 1996; 5: 1183-90.
  20. Mc Lean TR, Simmons K, Svensson LG. Management of postoperative intra-abdominal abscesses by routine percutaneous drainage. Surg Gynecol Obstet 1993; 176: 167-77.
  21. Isbister W. Anastomotic leak in colorectal surgery: a single surgeon's experience. A N Z J Surg 2001; 71:516-20.
  22. Sutton CD, Marshall LJ, Williams N et al. Colo-rectal anastomotic leakage often masquerades as a cardiac complication. Colorectal Dis 2004; 6:21-22.