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Early Detection of Anastomotic Leakage After Elective Low Anterior Resection

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Colorectal anastomotic leakage is a serious complication leading to major postoperative morbidity and mortality. In the present study, we investigated the early detection of anastomotic leakage before its clinical presentation.

Method

Fifty-six patients with rectal cancer were included prospectively in this study. All patients underwent elective low anterior resection. Peritoneal samples were collected from the abdominal drains at the first, third, and fifth days postoperatively for bacteriological study (quantitative cultures for both aerobes and anaerobes) and cytokines (IL-6, IL-10, TNF) measurement. Patients were divided into two groups: those without symptomatic or clinical evidence of anastomotic leakage (AL; group 1) and those with clinical evidence of AL (group 2). Study variables included hospital stay, wound infection, operative time, blood loss, height of anastomosis, intraperitoneal cytokines, and microbiological study of peritoneal fluid.

Result

Clinically evident AL occurred in eight patients (14.3%) and diagnosed postoperatively on median day 6. Intraperitoneal bacterial colonization and cytokine levels were significantly higher in patients with clinical evidence of AL. Wound infection was significantly higher in anastomotic leakage group. The hospital stay for the patients with anastomotic leakage was significantly longer than those without AL (14 ± 1.41 vs. 5.43 ± 0.89 days). A significant difference among two groups was observed regarding operative time, blood loss, blood transfusion, and height of the anastomosis.

Conclusion

The peritoneal cytokines levels and intraperitoneal bacterial colonization might be an additional diagnostic tool that can support the decision making of surgeons for early detection of anastomotic leak in colorectal surgery.

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Authors and Affiliations

  1. General Surgery Department, Colorectal Unit, Mansoura University Hospital, Mansoura, Egypt

    Elyamani Fouda, Ayman El Nakeeb, Alaa Magdy & Mohamed Farid

  2. Microbiology Department, Faculty of medicine, Mansoura University, Mansoura, Egypt

    Enas A. Hammad

  3. Biochemistry Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt

    Gamal Othman

Authors
  1. Elyamani Fouda
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  2. Ayman El Nakeeb
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  3. Alaa Magdy
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  6. Mohamed Farid
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Correspondence to Ayman El Nakeeb.

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This manuscript has not been submitted for publication in any other journal and will not subsequently be submitted for potential publication in another journal until a decision has been made, nor has it been published previously in any media.

Author contributions are as follows: Elyamani Fouda, Ayman El Nakeeb, Enas A. Hammad, Gamal Othman, and Mohamed Farid designed the research. Elyamani Fouda, Ayman El Nakeeb, Alaa Magdy, Enas A. Hammad, and Gamal Othman performed the research. Elyamani Fouda, Ayman El Nakeeb, and Alaa Magdy analyzed the data. Elyamani Fouda and Ayman El Nakeeb wrote the paper.

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Fouda, E., El Nakeeb, A., Magdy, A. et al. Early Detection of Anastomotic Leakage After Elective Low Anterior Resection. J Gastrointest Surg 15, 137–144 (2011). https://doi.org/10.1007/s11605-010-1364-y

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  • DOI: https://doi.org/10.1007/s11605-010-1364-y

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