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Intraoperative air leak test reduces the rate of postoperative anastomotic leak: analysis of 777 laparoscopic left-sided colon resections

  • 2018 SAGES Oral
  • Published:
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Abstract

Background

The evidence supporting the use of the air leak test (ALT) after laparoscopic left-sided colon resection (LLCR) to test the colorectal anastomosis (CA) integrity aiming at reducing the rate of postoperative CA leakage (CAL) is not conclusive. The aim of this study was to challenge the use of ALT after elective LLCR.

Methods

It is a retrospective analysis of a prospectively collected database including all patients undergoing elective LLCR with primary CA and no proximal bowel diversion between January 1996 and June 2017. The decision to perform the ALT was based on the individual surgeon routine practice. A multivariate analysis was performed to identify independent risk factors for CAL.

Results

A total of 777 LLCR without proximal diversion were included in the analysis: the CA was tested in 398 patients (ALT group), while intraoperative ALT was not performed in 379 patients (No-ALT group). The two groups were similar in demographic characteristics, indication, and type of procedure. Intraoperative ALT was positive in 20 (5%) patients: a stoma was created in 14 (70%) patients, while 6 (30%) patients had a suture repair alone. Overall, postoperative CAL occurred in 32 patients (4.1%): the postoperative CAL rate was lower in ALT patients (2.5% vs. 5.8%, p = 0.025). A reoperation was needed in 87.5% of cases. No CAL occurred in the 20 patients with intraoperative positive ALT. Multivariate analysis showed that ASA score 3–4 (OR 5.39, 95% CI 2.53–11.51, p < 0.001) and male sex (OR 3.96, 95% CI 1.66–9.43, p = 0.002) were independent risk factors for postoperative CAL, while intraoperative ALT independently reduced the postoperative CAL rate (OR 0.40, 95% CI 0.18–0.88, p = 0.022).

Conclusion

Intraoperative ALT allows to detect AL defects after LLCR that can be effectively managed intraoperatively, leading to a significant lower risk of postoperative CAL.

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Authors and Affiliations

  1. Department of Surgical Sciences, University of Torino, Corso A. M. Dogliotti, 14, 10126, Turin, Italy

    Marco Ettore Allaix, Adriana Lena, Maurizio Degiuli, Alberto Arezzo, Massimiliano Mistrangelo & Mario Morino

  2. Division of Nuclear Medicine, University of Torino, Turin, Italy

    Roberto Passera

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  1. Marco Ettore Allaix
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  2. Adriana Lena
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Correspondence to Marco Ettore Allaix.

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Drs. Marco Ettore Allaix, Adriana Lena, Maurizio Degiuli, Alberto Arezzo, Roberto Passera, Massimiliano Mistrangelo, and Mario Morino have no conflicts of interest or financial ties to disclose.

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Allaix, M.E., Lena, A., Degiuli, M. et al. Intraoperative air leak test reduces the rate of postoperative anastomotic leak: analysis of 777 laparoscopic left-sided colon resections. Surg Endosc 33, 1592–1599 (2019). https://doi.org/10.1007/s00464-018-6421-8

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  • DOI: https://doi.org/10.1007/s00464-018-6421-8

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