Air Leak, Colonic Ischemia, or Tension: How to Salvage the Failed Anastomosis

References

Operation

Study design

Sample size

No. of leaks

Definition

Test

Timing

Ambrosetti et al. [71]

CR

Cohort

199

5 (3)

No

WS contrast

Routinely on day 9–11

Biondo et al. [72]

CR

Cohort

63

3 (5)

No

Unspecified contrast

When suspected

Bokey et al. [73]

C/CR

Cohort

1846

79 (4)

Yes

WS contrast, abdominal reoperation

When suspected

Bouillot et al. [74]

C

Cohort

50

1 (2)

No

Unspecified radiography

Unclear

Burke et al. [75]

CR

RCT

186

7 (4)

Yes

WS contrast

Routinely on day 7 in first half of study, then changed to when leak suspected

Cornwell et al. [76]

C

Cohort

56

3 (5)

Yes

Surgical re-exploration, CT, or WS contrast

Variable

De Wever et al. [77]

CR

Cohort

16

5 (31)

No

Endoscopy and unspecified radiological test

3–4 months

Debus et al. [78]

CR

Cohort

77

6 (8)

No

Barium contrast

When suspected

Deen and Smart [79]

C

Cohort

53

2 (4)

Yes

Unspecified radiography

When suspected

Dehni et al. [80]

CR

Cohort

258

31 (12)

Yes

WS contrast, imaging, or reoperation

Routine contrast study 8–10 weeks before stoma

Docherty et al. [81]

CR

RCT

652

38 (6)

Yes

WS contrast, reoperation

Routine on day 4–14

Fingerhut et al. [82]

CR

RCT

159

10 (6)

Yes

WS contrast, sinography

Routine contrast study on day 7

Fingerhut et al. [83]

CR

RCT

113

17 (15)

Yes

WS contrast, sinography, reoperation

Routine contrast study on day 7

Hallbook et al. [84]

CR

RCT

97

9 (9)

Yes

Digital and endoscopic examination, contrast, reoperation, CT closure

Routine contrast study before stoma closure

Hansen et al. [85]

CR

Cohort

615

9 (1)

Yes

Unspecified radiography

When suspected

Hida et al. [86]

CR

RCT

43

2 (5)

No

WS contrast

Routinely at 2 months

Iversen et al. [87]

CR

Cohort

161

17 (11)

No

WS contrast

When suspected

Junger et al. [88]

    

Yes

LPS concentration

LPS level assessed daily

Karanjia et al. [89]

CR

Cohort

219

38 (17)

Yes

WS contrast

When suspected

Kessler et al. [90]

CR

MRCT

621

88 (14)

Yes

Unspecified radiological tests, methylene blue test

When suspected

Kockerling et al. [91]

CR

MRCT

949

46 (5)

No

Unspecified

Unspecified

Kracht et al. [92]

C

MRCT

440

31 (7)

Yes

WS contrast, reoperation

Routine contrast on day 8–10

Mann et al. [93]

CR

Cohort

370

11 (3)

Yes

WS contrast

When suspected

Merad et al. [94]

CR

RCT

705

53 (8)

Yes

WS contrast, reoperation

Routine contrast on day 8

Merad et al. [95]

CR

RCT

494

32 (6)

Yes

WS contrast, reoperation

Routine contrast on day 7

Miller et al. [96, 97]

CR

Cohort

103

6 (6)

Yes

WS contrast

Routine contrast on day 10

Moore et al. [98]

CR

Cohort

300

34 (11)

No

Unspecified radiological examination, reoperation (clinically significant)

Routine before stoma closure

Norris et al. [99]

L

Cohort

156

6 (4)

No

Unspecified imaging or reoperation

When suspected

Pakkastie et al. [100]

CR

RCT

38

15 (39)

Yes

WS contrast

Routine contrast on day 7–10

Petersen et al. [101]

CR

Cohort

467

41 (9)

Yes

WS contrast

When suspected

Redmond et al. [102]

CR

Cohort

111

13 (12)

Yes

WS contrast

Routine contrast on day 10–12

Sagar et al. [103]

CR

RCT

100

12 (12)

Yes

WS contrast

Routine contrast on day 5–7

Santos et al. [104]

CR

RCT

149

11 (7)

Yes

Unspecified radiological examination

When suspected

Slim et al. [105]

Lap. CR

Cohort

65

6 (9)

Yes

WS contrast, reoperation for peritonitis

When suspected

Stewart et al. [106]

CR

RCT

88

1 (1)

Yes

Unspecified

Unspecified

Tagart [107]

CR

Cohort

220

79 (36)

No

Limited barium contrast

Routine contrast on day 14

Thompson et al. [108]

CR

Cohort

535

18 (3)

No

None

Unspecified (not done routinely)

Watson et al. [109]

C/CR

Cohort

477

9 (2)

No

WS contrast

When suspected

Wheeler and Gilbert [110]

CR

Cohort

102

7 (7)

No

WS contrast

Routine contrast on day 8

Used with permission of John Wiley and Sons from Bruce et al. [15]

Values in parentheses are percentages

C colonic resection, CR colorectal surgery, CT computed tomography, L laparotomy (for Crohn’s disease), Lap laparoscopic, LPS lipopolysaccharide, MRCT multi-randomized clinical trial, RCT randomized clinical trial, WS water soluble

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May 2, 2020 | Posted by in GASTOINESTINAL SURGERY | Comments Off on Air Leak, Colonic Ischemia, or Tension: How to Salvage the Failed Anastomosis

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