Abstract
Purpose
Anastomotic leakage is a serious complication after colorectal surgery, and many risk factors for this problem have so far been identified. The aim of this study was to assess the association between visceral arterial occlusive disease and anastomotic leakage.
Methods
The preoperative abdominal computed tomography scans from all consecutive patients who underwent colorectal surgery with anastomosis in 2010 were retrospectively analyzed.
Results
A total of 242 patients were included, with a median age of 65 years (interquartile range 55–74). Anastomotic leakage occurred in 14 % of cases (n = 34). The mortality rate was 3 % (n = 8). There was no association between atherosclerosis of the visceral or iliac arteries and anastomotic leakage. There was also no association between right-sided or left-sided resections and total occlusion of the superior or inferior mesenteric artery, respectively.
Conclusion
Asymptomatic visceral artery occlusive disease is not a risk factor for anastomotic leakage after colorectal surgery, and additional radiological imaging or percutaneous transluminal angioplasty for occluded visceral vessels is not indicated prior to colorectal surgery.
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References
Buchs NC, Gervaz P, Secic M, Bucher P, Mugnier-Konrad B, Morel P. Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study. Int J Colorectal Dis. 2007;23:265–70.
Hyman N, Manchester TL, Osler T, Burns B, Cataldo PA. Anastomotic leaks after intestinal anastomosis: it’s later than you think. Ann Surg. 2007;245:254–8.
Komen N, Dijk JW, Lalmahomed Z, Klop K, Hop W, Kleinrenskink G, Jeeked H, et al. After-hours colorectal surgery: a risk factor for anastomotic leakage. Int J Colorectal Dis. 2009;24:789–95.
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.
Matthiessen P, Hallböök O, Rutegård J, Simert G, Sjödahl R. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg. 2007;246:207–14.
Matthiessen P, Hallböök O, Andersson M, Rutegård J, Sjödahl R. Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis. 2004;6:464–9.
Platell C, Barwood N, Dorfmann G, Makin G. The incidence of anastomotic leaks in patients undergoing colorectal surgery. Colorectal Dis. 2007;9:71–9.
Sørensen LT, Jørgensen T, Kirkeby LT, Skovdal J, Vennits B, Wille-Jørgensen P. Smoking and alcohol abuse are major risk factors for anastomotic leakage in colorectal surgery. Br J Surg. 1999;86:927–31.
Tuson JR, Everett WG. A retrospective study of colostomies, leaks and strictures after colorectal anastomosis. Int J Colorectal Dis. 1990;5:44–548.
Kruschewski M, Rieger H, Pohlen U, Hotz HG, Buhr HJ. Risk factors for clinical anastomotic leakage and postoperative mortality in elective surgery for rectal cancer. Int J Colorectal Dis. 2007;22:919–27.
Alves A, Panis Y, Trancart D, Regimbeau JM, Pocard M, Valleur P. Factors associated with clinically significant anastomotic leakage after large bowel resection: multivariate analysis of 707 patients. World J Surg. 2002;26:499–502.
Choi HK, Law WL, Ho JW. Leakage after resection and intraperitoneal anastomosis for colorectal malignancy: analysis of risk factors. Dis Colon Rectum. 2006;49:1719–25.
Makela JT, Kiviniemi H, Laitinen S. Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis. Dis Colon Rectum. 2003;46:653–60.
Kologlu M, Yorganci K, Renda N, Sayek I. Effect of local and remote ischemia–reperfusion injury on healing of colonic anastomoses. Surgery. 2000;128(1):99–104.
Kuzu MA, Tanik A, Kale IT, Aşlar AK, Köksoy C, Terzi C. Effect of ischemia/reperfusion as a systemic phenomenon on anastomotic healing in the left colon. World J Surg. 2000;24(8):990–4.
Post IL, Verheijen PM, Pronk A, Siccama I, Houweling PL. Intraoperative blood pressure changes as a risk factor for anastomotic leakage in colorectal surgery. Int J Colorectal Dis. 2012;27:765–72.
Boyle NH, Manifold D, Jordan MH, Mason RC. Intraoperative assessment of colonic perfusion using scanning laser Doppler flowmetry during colonic resection. J Am Coll Surg. 2000;191:504–10.
Vignali A, Gianotti L, Braga M, Radaelli G, Di Carlo V. Altered micro perfusion at the rectal stump is predictive for rectal anastomotic leak. Dis Colon Rectum. 2000;43:76–82.
Tekin K, Aytekin F, Ozden A, Bilgihan A, Erdem E, Sungurtekin U, et al. Antithrombin III prevents deleterious effects of remote ischemia–reperfusion injury on healing of colonic anastomoses. Am J Surg. 2002;184(2):160–5.
Scharff JR, Longo WE, Vartanian SM, Jacobs DL, Bahadursingh AN, Kaminski DL. Ischemic colitis: spectrum of disease and outcome. Surgery. 2003;134:624–9.
Komen N, Klitsie P, Dijk JW, Slieker J, Hermans J, Havenga K, et al. Calcium score: a new risk factor for colorectal anastomotic leakage. Am J Surg. 2011;201:759–65.
Barnett HJ, Taylor DW, Eliasziw M, Fox AJ, Ferguson GG, Haynes RB, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American symptomatic carotid endarterectomy trial collaborators. N Engl J Med. 1998;339(20):1415–25.
North American Symptomatic Carotid Endarterectomy Trial (NASCET), Steering Committee. Methods, patient characteristics, and progress. Stroke. 1991;22:711–20.
Järvinen O, Laurikka J, Sisto T, Salenius JP, Tarkka MR. Atherosclerosis of the visceral arteries. Vasa. 1995;24(1):9–14.
Croft RJ, Menon GP, Marston A. Does ‘intestinal angina’ exist? A critical study of obstructed visceral arteries. Br J Surg. 1981;68(5):316–8.
The European Stroke Organisation (ESO), ESC Committee for Practice Guidelines (CPG). ESC Guidelines on the diagnosis and treatment of peripheral artery diseases. Eur Heart J. 2011;32:2851–906.
Roobottom CA, Dubbins PA. Significant disease of the celiac and superior mesenteric arteries in asymptomatic patients: predictive value of Doppler sonography. AJR. 1993;161:985–8.
Conflict of interest
V. Kornmann, M. van Werkum, T. Bollen, B. van Ramshorst and D. Boerma have no conflicts of interest or financial ties to disclose.
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Kornmann, V.N.N., van Werkum, M.H., Bollen, T.L. et al. Compromised visceral circulation does not affect the outcome of colorectal surgery. Surg Today 44, 1220–1226 (2014). https://doi.org/10.1007/s00595-013-0730-2
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DOI: https://doi.org/10.1007/s00595-013-0730-2