eISSN: 2299-0054
ISSN: 1895-4588
Videosurgery and Other Miniinvasive Techniques
Current issue Archive Videoforum Manuscripts accepted About the journal Supplements Editorial board Journal's reviewers Abstracting and indexing Subscription Contact Instructions for authors Ethical standards and procedures
SCImago Journal & Country Rank

 
1/2021
vol. 16
 
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abstract:
Original paper

Colorectal anastomosis dehiscence: a call for more detailed morphological classification

Alexander Ferko
1
,
Jan Rejholoc
2
,
Matej Škrovina
3
,
Ilja Tachecí
4
,
Igor Sirák
5

1.
Department of Surgery and Transplant Center, Comenius University, Jessenius Medical Faculty Martin and University Hospital Martin, Bratislava, Slovak Republic
2.
Department of General Surgery, Regional Health Ltd., Hospital Děčín, Děčín, Czech Republic
3.
Department of Surgery, Hospital Nový Jičin, Nový Jičin, Czech Republic
4.
2nd Department of Internal Medicine, Charles University, Medical Faculty Hradec Králové, University Hospital Hradec Králové, Hradec Králové, Czech Republic
5.
Department of Oncology and Radiotherapy, Charles University, Medical Faculty Hradec Králové, University Hospital, Hradec Králové, Czech Republic
Videosurgery Miniinv 2021; 16 (1): 98–109
Online publish date: 2020/07/16
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Introduction
A proactive approach is recommended in colorectal anastomosis leak treatment, and early diagnosis is very important. Early postoperative endoscopy would allow rapid diagnosis of anastomotic pathologies and consequent prompt intervention according to anastomotic disruption morphology.

Aim
To evaluate the effectiveness of close endoscopic follow-up of all patients (including asymptomatic ones) in improving diagnosis of acute leak (AL) and reducing its complications.

Material and methods
This study included 124 patients who had undergone rectum resection for rectal cancer with stapled anastomosis. Endoscopy was performed between the 7th and 10th postoperative day and 1 month postoperatively. For defect morphology assessment, a classification system was created based on four levels of severity. Photographic findings were evaluated by an independent, experienced gastroenterologist.

Results
Postoperative endoscopy revealed 28 (22.6%) patients with acute leakage. Initial endoscopy confirmed AL in 18 patients. Six (31.6%) patients were asymptomatic and 13 (68.4%) were symptomatic. The second endoscopy revealed another 9 (32.1%) leaks (4 (44.5%) asymptomatic and 5 (55.5%) symptomatic). Sixteen (57.1%) patients had grade A leakages, 7 (25.0%) had grade B leakages, and 5 (17.9%) had grade C leakages. Furthermore, 22 of 27 (81%) defects were located posterior and posterior-laterally. Fifteen (55.5%) defects were smaller than 1/3 the circumference, 7 (25.9%) affected 1/3–1/2 of the circumference, and 5 (18.5%) affected more than 1/2 of the circumference.

Conclusions
Incorporation of early endoscopy in postoperative management allows rapid diagnosis of AL and allows faster intervention, even in leaks that are clinically silent.

keywords:

rectal cancer, anastomotic leak, low anterior resection

  
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