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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