Management of Anastomotic Leakage after Colorectal Resection: Survey among the German CHIR-Net Centers
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Characteristics of the Participating Centers (Table S1a)
3.2. Perioperative Management (Table S1b)
3.3. Diagnosis of a Leakage of the Colorectal Anastomosis (Table S1c)
3.4. General Aspects of the Management of Colorectal Anastomotic Leakage (Table S1d)
3.5. Management of Colorectal Anastomotic Leakage Based on ISREC Grading in Combination with the Clinical Condition of the Patient, Presence of Ostomy and Bowel Perfusion
3.5.1. Clinical Condition of the Patient and Good Blood Perfusion at the Anastomotic Site
3.5.2. Clinical Condition of the Patient and Poor Perfusion of the Anastomosis
3.6. Methods to Manage a Leaking Colorectal Anastomosis
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Rickert, A.; Willeke, F.; Kienle, P.; Post, S. Management and outcome of anastomotic leakage after colonic surgery. Color. Dis. 2010, 12, e216–e223. [Google Scholar] [CrossRef] [PubMed]
- Nesbakken, A.; Nygaard, K.; Lunde, O.C.; Blucher, J.; Gjertsen, O.; Dullerud, R. Anastomotic leak following mesorectal excision for rectal cancer: True incidence and diagnostic challenges. Color. Dis. 2005, 7, 576–581. [Google Scholar]
- Mussetto, A.; Arena, R.; Buzzi, A.; Fuccio, L.; Dari, S.; Brancaccio, M.L.; Triossi, O. Long-term efficacy of vacuum-assisted therapy (Endo-SPONGE((R))) in large anastomotic leakages following anterior rectal resection. Ann. Gastroenterol. 2017, 30, 649–653. [Google Scholar] [PubMed]
- Platell, C.; Barwood, N.; Dorfmann, G.; Makin, G. The incidence of anastomotic leaks in patients undergoing colorectal surgery. Color. Dis. 2007, 9, 71–79. [Google Scholar] [CrossRef] [PubMed]
- Herrle, F.; Sandra-Petrescu, F.; Weiss, C.; Post, S.; Runkel, N.; Kienle, P. Quality of Life and Timing of Stoma Closure in Patients With Rectal Cancer Undergoing Low Anterior Resection with Diverting Stoma: A Multicenter Longitudinal Observational Study. Dis. Colon Rectum 2016, 59, 281–290. [Google Scholar] [PubMed]
- Kang, J.; Kim, H.; Park, H.; Lee, B.; Lee, K.Y. Risk factors and economic burden of postoperative anastomotic leakage related events in patients who underwent surgeries for colorectal cancer. PLoS ONE 2022, 17, e0267950. [Google Scholar]
- Rink, A.D.; Kienle, P.; Aigner, F.; Ulrich, A. How to reduce anastomotic leakage in colorectal surgery-report from German expert meeting. Langenbecks Arch. Surg. 2020, 405, 223–232. [Google Scholar] [CrossRef]
- Spinelli, A.; Anania, G.; Arezzo, A.; Berti, S.; Bianco, F.; Bianchi, P.P.; De Giuli, M.; De Nardi, P.; de Paolis, P.; Foppa, C.; et al. Italian multi-society modified Delphi consensus on the definition and management of anastomotic leakage in colorectal surgery. Updates Surg. 2020, 72, 781–792. [Google Scholar] [CrossRef]
- van Rooijen, S.J.; Jongen, A.C.; Wu, Z.Q.; Ji, J.F.; Slooter, G.D.; Roumen, R.M.; Bouvy, N.D. Definition of colorectal anastomotic leakage: A consensus survey among Dutch and Chinese colorectal surgeons. World J. Gastroenterol. 2017, 23, 6172–6180. [Google Scholar] [CrossRef]
- Rahbari, N.N.; Weitz, J.; Hohenberger, W.; Heald, R.J.; Moran, B.; Ulrich, A.; Holm, T.; Wong, W.D.; Tiret, E.; Moriya, Y.; et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: A proposal by the International Study Group of Rectal Cancer. Surgery 2010, 147, 339–351. [Google Scholar]
- Sandra-Petrescu, F.; Tzatzarakis, E.; Kahler, G.; Reissfelder, C.; Herrle, F. Management of colorectal anastomotic leakage using endoscopic negative pressure therapy with or without protective ostomy: A retrospective study. Int. J. Color. Dis. 2021, 36, 2261–2269. [Google Scholar]
- Kulu, Y.; Ulrich, A.; Bruckner, T.; Contin, P.; Welsch, T.; Rahbari, N.N.; Buchler, M.W.; Weitz, J. Validation of the International Study Group of Rectal Cancer definition and severity grading of anastomotic leakage. Surgery 2013, 153, 753–761. [Google Scholar] [CrossRef]
- Phitayakorn, R.; Delaney, C.P.; Reynolds, H.L.; Champagne, B.J.; Heriot, A.G.; Neary, P.; Senagore, A.J.; International Anastomotic Leak Study Group. Standardized algorithms for management of anastomotic leaks and related abdominal and pelvic abscesses after colorectal surgery. World J. Surg. 2008, 32, 1147–1156. [Google Scholar] [CrossRef]
- Daams, F.; Slieker, J.C.; Tedja, A.; Karsten, T.M.; Lange, J.F. Treatment of colorectal anastomotic leakage: Results of a questionnaire amongst members of the Dutch Society of Gastrointestinal Surgery. Dig. Surg. 2012, 29, 516–521. [Google Scholar] [CrossRef] [PubMed]
- Talboom, K.; Greijdanus, N.G.; van Workum, F.; Ubels, S.; Rosman, C.; Hompes, R.; de Wilt, J.H.W.; Tanis, P.J.; TENTACLE-Rectum working group. International expert opinion on optimal treatment of anastomotic leakage after rectal cancer resection: A case-vignette study. Int. J. Color. Dis. 2022, 37, 2049–2059. [Google Scholar] [CrossRef] [PubMed]
- Buia, A.; Post, S.; Buhr, H.J.; Hanisch, E. Bowel preparation for elective colorectal surgery in Germany 2017: Results of a survey among members of the German Society of General and Visceral Surgery. Der Chirurg 2019, 90, 564–569. [Google Scholar] [CrossRef] [PubMed]
- Kiran, R.P.; Murray, A.C.; Chiuzan, C.; Estrada, D.; Forde, K. Combined preoperative mechanical bowel preparation with oral antibiotics significantly reduces surgical site infection, anastomotic leak, and ileus after colorectal surgery. Ann. Surg. 2015, 262, 416–425; discussion 423–425. [Google Scholar] [CrossRef] [Green Version]
- Murray, A.C.; Kiran, R.P. Benefit of mechanical bowel preparation prior to elective colorectal surgery: Current insights. Langenbecks Arch. Surg. 2016, 401, 573–580. [Google Scholar]
- Willis, M.A.; Toews, I.; Soltau, S.L.; Kalff, J.C.; Meerpohl, J.J.; Vilz, T.O. Preoperative combined mechanical and oral antibiotic bowel preparation for preventing complications in elective colorectal surgery. Cochrane Database Syst. Rev. 2023, 2, CD014909. [Google Scholar]
- Kouladouros, K.; Belle, S.; Reissfelder, C.; Kahler, G. Endoscopic negative pressure therapy for leaks with large cavities in the upper gastrointestinal tract: Is it a feasible therapeutic option? Scand. J. Gastroenterol. 2021, 56, 193–198. [Google Scholar]
- Kahler, G. Anastomotic Leakage after Upper Gastrointestinal Surgery: Endoscopic Treatment. Visc. Med. 2017, 33, 202–206. [Google Scholar] [CrossRef]
- Clifford, R.E.; Fowler, H.; Govindarajah, N.; Vimalachandran, D.; Sutton, P.A. Early anastomotic complications in colorectal surgery: A systematic review of techniques for endoscopic salvage. Surg. Endosc. 2019, 33, 1049–1065. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Huser, N.; Michalski, C.W.; Erkan, M.; Schuster, T.; Rosenberg, R.; Kleeff, J.; Friess, H. Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann. Surg. 2008, 248, 52–60. [Google Scholar] [CrossRef] [PubMed]
- Karampinis, I.; Keese, M.; Jakob, J.; Stasiunaitis, V.; Gerken, A.; Attenberger, U.; Post, S.; Kienle, P.; Nowak, K. Indocyanine Green Tissue Angiography Can Reduce Extended Bowel Resections in Acute Mesenteric Ischemia. J. Gastrointest. Surg. 2018, 22, 2117–2124. [Google Scholar] [CrossRef]
- Abdelrahman, H.; El-Menyar, A.; Peralta, R.; Al-Thani, H. Application of indocyanine green in surgery: A review of current evidence and implementation in trauma patients. World J. Gastrointest. Surg. 2023, 15, 757–775. [Google Scholar] [CrossRef]
- Flores-Rodriguez, E.; Garrido-Lopez, L.; Sanchez-Santos, R.; Cano-Valderrama, O.; Rodriguez-Fernandez, L.; Nogueira-Sixto, M.; Paniagua-Garcia Senorans, M.; Vigorita, V.; Moncada-Iribarren, E. Is ICG essential in all colorectal surgery? A 3-year experience in a single center: A cohort study. Int. J. Color. Dis. 2023, 38, 67. [Google Scholar] [CrossRef]
- Ando, Y.; Takahashi, A.; Fujii, M.; Hasegawa, H.; Kimura, T.; Yamamoto, H.; Tajima, T.; Nishiguchi, Y.; Kakeji, Y.; Miyata, H.; et al. Survey Regarding Gastrointestinal Stoma Construction and Closure in Japan. Ann. Gastroenterol. Surg. 2022, 6, 212–226. [Google Scholar] [CrossRef]
- Arezzo, A.; Migliore, M.; Chiaro, P.; Arolfo, S.; Filippini, C.; Di Cuonzo, D.; Cirocchi, R.; Morino, M.; Collaborators, R.S. The REAL (REctal Anastomotic Leak) score for prediction of anastomotic leak after rectal cancer surgery. Tech. Coloproctol. 2019, 23, 649–663. [Google Scholar] [CrossRef]
- Dekker, J.W.; Liefers, G.J.; de Mol van Otterloo, J.C.; Putter, H.; Tollenaar, R.A. Predicting the risk of anastomotic leakage in left-sided colorectal surgery using a colon leakage score. J. Surg. Res. 2011, 166, e27–e34. [Google Scholar] [CrossRef]
- Seyfried, S.; Herrle, F.; Schroter, M.; Hardt, J.; Betzler, A.; Rahbari, N.N.; Reissfelder, C. Initial experiences with the implementation of the enhanced recovery after surgery (ERAS(R)) protocol. Der Chirurg 2021, 92, 428–433. [Google Scholar] [CrossRef] [PubMed]
ISREC Grade | ASA 1–2; <80Y | Ostomy | Ischemia | Extraperitoneal |
---|---|---|---|---|
B (antibiotics, percutaneous or transanal drainage, transanal lavage) | + * | − | − | +/− |
+ ** | + | − | +/− | |
− | + | − | + | |
C (re-surgery: laparotomy or laparoscopy) | ||||
preservation of the anastomosis | + */− | − | − | +/− |
+ **/− | + | − | +/− | |
+ | + | + | + | |
anastomosis take down | +/− | − | + | +/− |
− | + | + | +/− |
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Șandra-Petrescu, F.; Rahbari, N.N.; Birgin, E.; Kouladouros, K.; Kienle, P.; Reissfelder, C.; Tzatzarakis, E.; Herrle, F. Management of Anastomotic Leakage after Colorectal Resection: Survey among the German CHIR-Net Centers. J. Clin. Med. 2023, 12, 4933. https://doi.org/10.3390/jcm12154933
Șandra-Petrescu F, Rahbari NN, Birgin E, Kouladouros K, Kienle P, Reissfelder C, Tzatzarakis E, Herrle F. Management of Anastomotic Leakage after Colorectal Resection: Survey among the German CHIR-Net Centers. Journal of Clinical Medicine. 2023; 12(15):4933. https://doi.org/10.3390/jcm12154933
Chicago/Turabian StyleȘandra-Petrescu, Flavius, Nuh N. Rahbari, Emrullah Birgin, Konstantinos Kouladouros, Peter Kienle, Christoph Reissfelder, Emmanouil Tzatzarakis, and Florian Herrle. 2023. "Management of Anastomotic Leakage after Colorectal Resection: Survey among the German CHIR-Net Centers" Journal of Clinical Medicine 12, no. 15: 4933. https://doi.org/10.3390/jcm12154933
APA StyleȘandra-Petrescu, F., Rahbari, N. N., Birgin, E., Kouladouros, K., Kienle, P., Reissfelder, C., Tzatzarakis, E., & Herrle, F. (2023). Management of Anastomotic Leakage after Colorectal Resection: Survey among the German CHIR-Net Centers. Journal of Clinical Medicine, 12(15), 4933. https://doi.org/10.3390/jcm12154933