424
IRUS Total
Downloads

Anastomotic leaks can be detected within 5 days following ileorectal anastomosis: A case-controlled study in patients with familial adenomatous polyposis

Title: Anastomotic leaks can be detected within 5 days following ileorectal anastomosis: A case-controlled study in patients with familial adenomatous polyposis
Authors: Aziz, O
Albeyati, A
Derias, M
Varsani, N
Ashrafian, H
Athanasiou, T
Clark, SK
Jenkins, JT
Kennedy, RH
Item Type: Journal Article
Abstract: AIM: To determine the earliest time point at which anastomotic leaks can be detected in patients undergoing total colectomy (TC) with primary ileorectal anastomosis (IRA) for Familial Adenomatous Polyposis (FAP). METHOD: A case-controlled study of 10 anastomotic leak patients versus 20 controls following laparoscopic TC with IRA for FAP (from 96 consecutive patients between 2006-2013). Panel time-series data regression was performed using a double subscript structure to include both variables. A generalized least squares multi-variate approach was applied in a random effects setting to calculate correlations for observations, with anastomotic leak being the dependent variable. Univariate and multivariate regression calculations were then performed according to individual observations at each recorded time point. Time-series analysis was used to determine when a variable became significant in the leak group. RESULTS: Multivariate analysis identified a significant difference between leak and control groups in mean heart rate (p=<0.001), mean respiratory rate (p=0.017), and mean urine output (p=0.001). Time-point analysis showed that heart rate was significantly different between leak and control groups at post-operative day 4.25. Multivariate analysis identified a significant difference between groups in ALT (p=0.006), Bilirubin (p=0.008), Creatinine (p=0.001), Haemoglobin (p=<0.001), and Urea (p=0.007). There were no differences between groups with regards to markers of inflammation such as albumin, white blood cell count, neutrophil count, and CRP. CONCLUSION: Anastomotic leaks can be detected early (within 4.5 days of surgery) through changes in physiological, blood test, and observational parameters, providing an opportunity for early intervention in these patients to salvage the anastomosis. This article is protected by copyright. All rights reserved.
Issue Date: 22-Jul-2016
Date of Acceptance: 1-Jun-2016
URI: http://hdl.handle.net/10044/1/39279
DOI: https://dx.doi.org/10.1111/codi.13467
ISSN: 1463-1318
Publisher: Wiley
Start Page: 251
End Page: 259
Journal / Book Title: Colorectal Disease
Volume: 19
Issue: 3
Copyright Statement: © 2016 The Association of Coloproctology of Great Britain and Ireland. This article is protected by copyright. All rights reserved. This is the accepted version of the following article: Aziz, O., Albeyati, A., Derias, M., Varsani, N., Ashrafian, H., Athanasiou, T., Clark, S. K., Jenkins, J. T. and Kennedy, R. H. (2016), Anastomotic leaks can be detected within 5 days following ileorectal anastomosis: A case-controlled study in patients with familial adenomatous polyposis. Colorectal Dis., which has been published in final form at http://dx.doi.org/10.1111/codi.13467.
Keywords: Science & Technology
Life Sciences & Biomedicine
Gastroenterology & Hepatology
Surgery
Anastomotic leak
ileorectal anastomosis
laparoscopic
familial adenomatous polyposis
POUCH-ANAL ANASTOMOSIS
COLORECTAL-CANCER SURGERY
CONTROLLED CLINICAL-TRIAL
LOW ANTERIOR RESECTION
ILEAL POUCH
RISK-FACTORS
ENHANCED RECOVERY
CIRCULAR STAPLES
HAND-SEWN
MORBIDITY
Adenomatous Polyposis Coli
Adolescent
Adult
Anastomosis, Surgical
Anastomotic Leak
Case-Control Studies
Colectomy
Databases, Factual
Female
Humans
Ileum
Laparoscopy
Least-Squares Analysis
Male
Middle Aged
Multivariate Analysis
Rectum
Regression Analysis
Time Factors
Young Adult
1103 Clinical Sciences
Publication Status: Published
Appears in Collections:Department of Surgery and Cancer