Abstract
Gastrointestinal anastomosis leakage is still the major complication following abdominal surgery. Many conditions including hypoalbuminemia, chronic obstructive pulmonary disease, hypovolemia, anemia, and hypoxemia, prolonged operative time, blood loss, blood transfusions, colon cancer, and inflammatory bowel disease have been identified as significant risk factors. Despite the improved perioperative assessment, the standardization of surgical technique, and the use of innovative devices, the incidence of gastrointestinal anastomosis leakage ranges from 2 to 12 %. We performed experimental studies comparing from a biochemical point of view, and from a tensiometric one in vitro, segments of small and large bowel resected and anastomosed. In the second phase of our experimental trials, we investigated if the biochemical differences between small and large bowel were associated with differences in motility and peristalsis. In the further step, we investigated if the pericardium bovine patch wrapping ileoileal and colo-colonic hand-sewn anastomosis in pigs seals the suture line and promotes anastomotic healing.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Telem D, Chin E, Nguyen S et al (2010) Risk factors for anastomotic leak following colorectal surgery. A case–control study. Arch Surg 145:371–375
Kang CY, Halabi WJ, Chaudhry OO et al (2013) Risk factors for anastomotic leakage after anterior resection for rectal cancer. JAMA Surg 148(1):65–71
Golub R, Golub RW, Cantu R Jr et al (1997) A multivariate analysis of factors contributing to leakage of intestinal anastomoses. J Am Coll Surg 184:364–372
Trencheva K, Morrissey KP, Wells M et al (2013) Identifying important predictors for anastomotic leak after colon and rectal resection: prospective study on 616 patients. Ann Surg 257(1):108–113
Snijders HS, Wouters MW, van Leersum NJ et al (2012) Meta-analysis of the risk for anastomotic leakage, the postoperative mortality caused by leakage in relation to the overall postoperative mortality. Eur J Surg Oncol 38(11):1065–1070
Branagan G, Finnis D, Colorectal Cancer Audit Working Group et al (2005) Prognosis after anastomotic leakage in colorectal surgery. Dis Colon Rectum 48:1021–1026
Sierzega M, Kolodziejczyk P, Kulig J, Polish Gastric Cancer Study Group et al (2010) Impact of anastomotic leakage on long-term survival after total gastrectomy for carcinoma of the stomach. Br J Surg 97(7):1035–1042
Deguchi Y, Fukagawa T, Morita S et al (2012) Identification of risk factors for esophagojejunal anastomotic leakage after gastric surgery. World J Surg 36(7):1617–1622
Markar SR, Arya S, Karthikesalingam A et al (2013) Technical factors that affect anastomotic integrity following esophagectomy: systematic review and meta-analysis. Ann Surg Oncol 20(13):4274–81
Rutegård J, Rutegård M (2012) Non-steroidal anti-inflammatory drugs in colorectal surgery: a risk factor for anastomotic complications? World J Gastrointest Surg 4(12):278–280
Klein M, Gögenur I, Rosenberg J et al (2012) Postoperative use of non-steroidal anti-inflammatory drugs in patients with anastomotic leakage requiring reoperation after colorectal resection: cohort study based on prospective data. BMJ 26(9):345, 1–13
Warschkow R, Steffen T, Thierbach J et al (2011) Risk factors for anastomotic leakage after rectal cancer resection and reconstruction with colorectostomy. A retrospective study with bootstrap analysis. Ann Surg Oncol 18(10):2772–2782
Testini M, Margari A, Amoruso M et al (2000) The dehiscence of colorectal anastomoses: the risk factors. Ann Ital Chir 71:433–440
Boccola MA, Buettner PG, Rozen WM et al (2011) Risk factors and outcomes for anastomotic leakage in colorectal surgery: a single-institution analysis of 1576 patients. World J Surg 35(1):186–195
Shogan BD, Carlisle EM, Alverdy JC et al (2013) Do we really know why colorectal anastomoses leak? J Gastrointest Surg 17(9):1698–1707
Miccini M, Borghese O, Scarpini M et al (2011) Anastomotic leakage and septic complications: impact on local recurrence in surgery of low rectal cancer. Ann Ital Chir 82(2):117–123
Matthiessen P, Hallböök O, Rutegård J et al (2007) Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg 246:207–214
Kim JJ, Liang MK, Subramanian A et al (2011) Predictors of relaparotomy after nontrauma emergency general surgery with initial fascial closure. Am J Surg 202(5):549–552
Harris LJ, Moudgill N, Hager E et al (2009) Incidence of anastomotic leak in patients undergoing elective colon resection without mechanical bowel preparation: our updated experience and two-year review. Am Surg 75(9):828–833
Boccola MA, Lin J, Rozen WM et al (2010) Reducing anastomotic leakage in oncologic colorectal surgery: an evidence-based review. Anticancer Res 30(2):601–607
Korolija D (2008) The current evidence on stapled versus hand-sewn anastomoses in the digestive tract. Minim Invasive Ther Allied Technol 17(3):151–154
Montesani C, De Milito R, Chiappalone S et al (1992) Critical evaluation of the anastomoses in large bowel experience in 533 cases. Hepatogastroenterology 39:304–308
El-Gazzaz G, Geisler D, Hull T et al (2010) Surgery: risk of clinical leak after laparoscopic versus open bowel anastomosis. Surg Endosc 24(8):1898–1903
Hotta T, Yamaue H (2011) Laparoscopic surgery for rectal cancer: review of published literature 2000–2009. Surg Today 41(12):1583–1591
Hansen O, Schwenk W, Hucke HP et al (1996) Colorectal stapled anastomoses. Dis Colon Rectum 39:30–36
Schietroma M, Carlei F, Cecilia EM et al (2012) Colorectal infraperitoneal anastomosis: the effects of perioperative supplemental oxygen administration on the anastomotic dehiscence. J Gastrointest Surg 16(2):427–434
Testini M, Scacco S, Loiotila L et al (1998) Comparison of oxidative phosphorylation in the small vs large bowel anastomosis. Eur Surg Res 30(1):1–7
Testini M, Piccinni G et al (1999) Wound healing of intestinal anastomosis after digestive surgery under septic condition. World J Surg 23:1315–1316
Testini M, Portincasa P, Scacco S et al (2002) Contractility in vitro and mitochondrial response in small and large anastomized rabbit bowel. World J Surg 26:493–498
Testini M, Miniello S, Piccinni G et al (2003) Correlation between chronic obstructive bronchial disease and colonic anastomosis dehiscence in the elderly. Ann Ital Chir 74:247–250
Portincasa P, Testini M et al (2011) The apposition of a resorbable pericardial Bovine patch (Tutomesh®) on intestinal anastomoses improves functional mucosal recovery in pig ileum and colon assessed by using chamber electrophysiological studies. Gastroenterology 140(5 suppl 1):S-656
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 Springer-Verlag Italia
About this chapter
Cite this chapter
Testini, M., Franco, I.F., Ferraro, V., Gurrado, A., Lissidini, G. (2014). Analysis of Surgical Risk Factors in Tailoring Digestive Anastomosis. In: Galloro, G. (eds) Endoscopic Follow-up of Digestive Anastomosis. Springer, Milano. https://doi.org/10.1007/978-88-470-5370-0_1
Download citation
DOI: https://doi.org/10.1007/978-88-470-5370-0_1
Published:
Publisher Name: Springer, Milano
Print ISBN: 978-88-470-5369-4
Online ISBN: 978-88-470-5370-0
eBook Packages: MedicineMedicine (R0)