Skip to main content
SpringerLink
Log in

Anastomosis Viability Assessment in Colorectal Surgery

  • Chapter
  • First Online:
Video Atlas of Intraoperative Applications of Near Infrared Fluorescence Imaging

  • 404 Accesses

Abstract

Anastomotic leak remains one of the most dreaded complications in colorectal surgery and is responsible for significant morbidity and mortality. While the risk for anastomotic leak is multifactorial and may not be totally eliminated, there has been much evidence that intraoperative fluorescence angiography is a safe and easy technique by which the incidence of anastomotic leaks can be reduced. We will review the risk factors for anastomotic leak, the technique of fluorescence angiography, and significant publications on this topic.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. McDermott FD, Heeney A, Kelly ME, Steele RJ, Carlson GL, Winter DC. Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg. 2015. 2015;102(5):462–79.

    Article  CAS  Google Scholar 

  2. Jafari MD, Wexner SD, Martz JE, McLemore EC, Margolin DA, Sherwinter DA, et al. Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II): a multi-institutional study. J Am Coll Surg. 2015;220(1):82–92 e1.

    Article  Google Scholar 

  3. Hammond J, Lim S, Wan Y, Gao X, Patkar A. The burden of gastrointestinal anastomotic leaks: an evaluation of clinical and economic outcomes. J Gastrointest Surg. 2014;18(6):1176–85.

    Article  Google Scholar 

  4. Caulfield H, Hyman NH. Anastomotic leak after low anterior resection: a spectrum of clinical entities. JAMA Surg. 2013;148(2):177–82.

    Article  Google Scholar 

  5. Ashburn JH, Stocchi L, Kiran RP, Dietz DW, Remzi FH. Consequences of anastomotic leak after restorative proctectomy for cancer: effect on long-term function and quality of life. Dis Colon Rectum. 2013;56(3):275–80.

    Article  Google Scholar 

  6. Marinatou A, Theodoropoulos GE, Karanika S, Karantanos T, Siakavellas S, Spyropoulos BG, Toutouzas K, Zografos G. Do anastomotic leaks impair postoperative health-related quality of life after rectal cancer surgery? A case-matched study. Dis Colon Rectum. 2014;57(2):158–66.

    Article  Google Scholar 

  7. Hallbook O, Sjodahl R. Anastomotic leakage and functional outcome after anterior resection of the rectum. Br J Surg. 1996;83(1):60–2.

    Article  CAS  Google Scholar 

  8. Nesbakken A, Nygaard K, Lunde OC. Outcome and late functional results after anastomotic leakage following mesorectal excision for rectal cancer. Br J Surg. 2001;88(3):400–4.

    Article  CAS  Google Scholar 

  9. Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg. 2011;253(5):890–9.

    Article  Google Scholar 

  10. Lu ZR, Rajendran N, Lynch AC, Heriot AG, Warrier SK. Anastomotic leaks after restorative resections for rectal cancer compromise cancer outcomes and survival. Dis Colon Rectum. 2016;59(3):236–44.

    Article  Google Scholar 

  11. Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg. 1998;85(3):355–8.

    Article  CAS  Google Scholar 

  12. Bertelsen CA, Andreasen AH, Jorgensen T, Harling H. Anastomotic leakage after anterior resection for rectal cancer: risk factors. Color Dis. 2010;12(1):37–43.

    Article  CAS  Google Scholar 

  13. 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.

    Article  Google Scholar 

  14. Stone HB, Coleman CN, Anscher MS, McBride WH. Effects of radiation on normal tissue: consequences and mechanisms. Lancet Oncol. 2003;4(9):529–36.

    Article  CAS  Google Scholar 

  15. Tibbs MK. Wound healing following radiation therapy: a review. Radiother Oncol. 1997;42(2):99–106.

    Article  CAS  Google Scholar 

  16. Enker WE, Merchant N, Cohen AM, et al. Safety and efficacy of low anterior resection for rectal cancer: 681 consecutive cases from a specialty service. Ann Surg. 1999;230(4):544–52.

    Article  CAS  Google Scholar 

  17. Nisar PJ, Lavery IC, Kiran RP. Influence of neoadjuvant radiotherapy on anastomotic leak after restorative resection for rectal cancer. J Gastrointest Surg. 2012;16(9):1750–7.

    Article  Google Scholar 

  18. Sharma A, Deeb AP, Rickles AS, Iannuzzi JC, Monson JR, Fleming FJ. Closure of defunctioning loop ileostomy is associated with considerable morbidity. Color Dis. 2013;15(4):458–62.

    Article  CAS  Google Scholar 

  19. Ricciardi R, Roberts PL, Marcello PW, Hall JF, Read TE, Schoetz DJ. Anastomotic leak testing after colorectal resection: what are the data? Arch Surg. 2009;144(5):407–11; discussion 411–2

    Article  Google Scholar 

  20. Ris F, Yeung T, Hompes R, Mortensen NJ. Enhanced reality and intraoperative imaging in colorectal surgery. Clin Colon Rectal Surg. 2015;28(3):158–64.

    Article  Google Scholar 

  21. Karliczek A, Harlaar NJ, Zeebregts CJ, Wiggers T, Baas PC, Van Dam GM. Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery. Int J Color Dis. 2009;24(5):569–76.

    Article  CAS  Google Scholar 

  22. Markus PM, Martell J, Leister I, Horstmann O, Brinker J, Becker H. Predicting postoperative morbidity by clinical assessment. Br J Surg. 2005;92:101–6.

    Article  CAS  Google Scholar 

  23. Boni L, David G, Mangano A, Dionigi G, Rausei S, Spampatti S, Cassinotti E, Fingerhut A. Clinical applications of indocyanine green (ICG) enhanced fluorescence in laparoscopic surgery. Surg Endosc. 2015;29(7):2046–55.

    Article  Google Scholar 

  24. Boni L, Fingerhut A, Marzorati A, Rausei S, Dionigi G, Cassinotti E. Indocyanine green fluorescence angiography during laparoscopic low anterior resection: results of a case-matched study. Surg Endosc. 2017;31:1836–40. https://doi.org/10.1007/s00464–016–5181–6.

    Article  PubMed  Google Scholar 

  25. Foppa C, Denoya PI, Tarta C, Bergamaschi R. Indocyanine green fluorescent dye during bowel surgery: are the blood supply “guessing days” over? Tech Coloproctol. 2014;18(8):753–8.

    Article  CAS  Google Scholar 

  26. Kudszus S, Roesel C, Schachtrupp A, Höer JJ. Intraoperative laser fluorescence angiography in colorectal surgery: a noninvasive analysis to reduce the rate of anastomotic leakage. Langenbeck's Arch Surg. 2010;395(8):1025–30.

    Article  Google Scholar 

  27. Jafari MD, Wexner SD, Martz JE, McLemore EC, Margolin DA, Sherwinter DA, Lee SW, Senagore AJ, Phelan MJ, Stamos MJ. Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II): a multi-institutional study. J Am Coll Surg. 2015;220(1):82–92.

    Article  Google Scholar 

  28. Ris F, Liot E, Buchs NC, Kraus R, et al. Multicentre phase II trial of near-infrared imaging in elective colorectal surgery. Br J Surg. 2018;105(10):1359–67.

    Article  CAS  Google Scholar 

  29. Chude GG, Rayate NV, Patris V, Koshariya M, Jagad R, Kawamoto J, Lygidakis NJ. Defunctioning loop ileostomy with low anterior resection for distal rectal cancer: should we make an ileostomy as a routine procedure? A prospective randomized study. Hepatogastroenterology. 2008;55(86–87):1562–7.

    CAS  PubMed  Google Scholar 

  30. Karliczek A, Benaron DA, Baas PC, Zeebregts CJ, Wiggers T, van Dam GM. Intraoperative assessment of microperfusion with visible light spectroscopy for prediction of anastomotic leakage in colorectal anastomoses. Color Dis. 2010;12(10):1018–25.

    Article  CAS  Google Scholar 

  31. Ashraf SQ, Burns EM, Jani A, Altman S, Young JD, Cunningham C, Faiz O, Mortensen NJ. The economic impact of anastomotic leakage after anterior resections in English NHS hospitals: are we adequately remunerating them? Color Dis. 2013;15(4):e190–8.

    Article  CAS  Google Scholar 

  32. Senagore A, Lane FR, Lee E, Wexner S, Dujovny N, Sklow B, Rider P, Bonello J. Bioabsorbable Staple Line Reinforcement Study Group. Bioabsorbable staple line reinforcement in restorative proctectomy and anterior resection: a randomized study. Dis Colon Rectum. 2014;57(3):324–30.

    Article  Google Scholar 

  33. Mongin C, Maggiori L, Agostini J, Ferron M, Panis Y. Does anastomotic leakage impair functional results and quality of life after laparoscopic sphincter-saving total mesorectal excision for rectal cancer? A case-matched study. Int J Color Dis. 2014;29(4):459–67.

    Article  Google Scholar 

  34. Leahy J, Schoetz D, Marcello P, Read T, Hall J, Roberts P, Ricciardi R. What is the risk of clinical anastomotic leak in the diverted colorectal anastomosis? J Gastrointest Surg. 2014;18(10):1812–6.

    Article  Google Scholar 

  35. Shiomi A, Ito M, Maeda K, Kinugasa Y, Ota M, Yamaue H, Shiozawa M, Horie H, Kuriu Y, Saito N. Effects of a diverting stoma on symptomatic anastomotic leakage after low anterior resection for rectal cancer: a propensity score matching analysis of 1,014 consecutive patients. J Am Coll Surg. 2015;220(2):186–94.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Colorectal Department, Cleveland Clinic Florida, Weston, FL, USA

    Mahmoud Abu Gazala

  2. Department of Colorectal Surgery, Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA

    Steven D. Wexner

Authors
  1. Mahmoud Abu Gazala
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Steven D. Wexner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Steven D. Wexner .

Editor information

Editors and Affiliations

  1. Department of General Surgery, Digestive Disease and Surgery Institute Cleveland Clinic Foundation, Cleveland, OH, USA

    Essa M. Aleassa

  2. Division of General Surgery Division of Surgical Oncology MetroHealth System, Cleveland, OH, USA

    Kevin M. El-Hayek

Electronic Supplementary Material

Evaluation of the bowel perfusion during sigmoid colectomy just prior to bowel transection. After we have decided on the location of the proximal site of division, an intravenous bolus of 3.5 mL of ICG is administered, and using a near-infrared (NIR) camera, the quality and distribution of florescence angiogram is evaluated. As can be seen in this video, there is a clear demarcation line between perfused and non-perfused bowel, allowing for a confident transection of bowel. (MP4 25665 kb)

Following creation of a colorectal anastomosis during this laparoscopic sigmoid colectomy, another bolus of ICG is administered in order to evaluate the serosal surface of the anastomosis. The video clearly demonstrates perfect anastomotic perfusion. (MP4 15867 kb)

Following colorectal anastomosis, a scope with NIR camera is inserted to the bowel lumen through the anus, and a third bolus of ICG is administered. This video demonstrates perfect anastomotic perfusion at the mucosal side of the anastomosis. (MP4 24814 kb)

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Abu Gazala, M., Wexner, S.D. (2020). Anastomosis Viability Assessment in Colorectal Surgery. In: Aleassa, E., El-Hayek, K. (eds) Video Atlas of Intraoperative Applications of Near Infrared Fluorescence Imaging. Springer, Cham. https://doi.org/10.1007/978-3-030-38092-2_19

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-38092-2_19

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-38091-5

  • Online ISBN: 978-3-030-38092-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation