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Achieving low anastomotic leak rates utilizing clinical perfusion assessment. Surgery 2016 10;160(4):960-967

Date

08/09/2016

Pubmed ID

27499148

DOI

10.1016/j.surg.2016.06.007

Scopus ID

2-s2.0-84994750881   13 Citations

Abstract

BACKGROUND: Anastomotic leak after colorectal resection increases morbidity, mortality, and in the setting of cancer, increases recurrences rates and reduces survival odds. Recent reports suggest that fluorescence evaluation of perfusion after colorectal anastomosis creation is associated with low anastomotic leak rates (1.4%). The purpose of this work was to evaluate whether a similar low anastomotic leak rate after left-sided colorectal resections could be achieved using standard assessment of blood flow to the bowel ends.

METHODS: We performed a retrospective chart review at an academic tertiary referral center, evaluating 317 consecutive patients who underwent a pelvic anastomosis after sigmoid colectomy, left colectomy, or low anterior resection. All operations were performed by a single surgeon from March 2008 to January 2015 with only standard clinical measures used to assess perfusion to the bowel ends. The primary outcome measure was the anastomotic leak rate as diagnosed by clinical symptoms, exam, or routine imaging.

RESULTS: The average patient age was 59.7 years with an average body mass index of 28.8 kg/m(2). Rectal cancer (128, 40.4%) was the most common indication for operation while hypertension (134, 42.3%) was the most common comorbidity. In total, 177 operations were laparoscopic (55.8%), 13 were reoperative resections (4.1%), and 108 were protected with a loop ileostomy (34.1%). Preoperative chemotherapy was administered to 25 patients (7.9%) while preoperative chemo/radiation was administered to 64 patients (20.2%). The anastomotic leak rate was 1.6% (5/317).

CONCLUSION: Our data suggests that standard, careful evaluation of adequate blood flow via inspection and confirmation of pulsatile blood flow to the bowel ends and meticulous construction of the colorectal or coloanal anastomoses can result in very low leak rates, similar to the rate reported when intraoperative imaging is used to assess perfusion.

Author List

Kream J, Ludwig KA, Ridolfi TJ, Peterson CY

Authors

Kirk A. Ludwig MD Chief, Professor in the Surgery department at Medical College of Wisconsin
Carrie Peterson MD, MS, FACS, FASCRS Associate Professor in the Surgery department at Medical College of Wisconsin
Timothy J. Ridolfi MD Associate Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Academic Medical Centers
Aged
Anastomosis, Surgical
Anastomotic Leak
Cohort Studies
Colectomy
Colorectal Neoplasms
Female
Follow-Up Studies
Humans
Incidence
Laparoscopy
Male
Middle Aged
Monitoring, Physiologic
Postoperative Care
Postoperative Complications
Pulsatile Flow
Regional Blood Flow
Regression Analysis
Retrospective Studies
Risk Assessment
Survival Analysis