Early anastomotic complications in colorectal surgery: a systematic review of techniques for endoscopic salvage

被引:33
作者
Clifford, R. E.
Fowler, H.
Govindarajah, N.
Vimalachandran, D.
Sutton, P. A.
机构
[1] Institute of Cancer Medicine, University of Liverpool, Liverpool
[2] The Countess of Chester Hospital NHS Foundation Trust, Chester
来源
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2019年 / 33卷 / 04期
关键词
Colorectal; Anastomotic leak; Stricture; Colonoscopy; Endoscopy; VACUUM-ASSISTED CLOSURE; ENDO-SPONGE TREATMENT; MESORECTAL EXCISION; ANTERIOR RESECTION; RECTAL-CANCER; LEAKAGE; MANAGEMENT; THERAPY; STENTS; EXPERIENCE;
D O I
10.1007/s00464-019-06670-9
中图分类号
R61 [外科手术学];
学科分类号
摘要
BackgroundAnastomotic complications following colorectal surgery are associated with significant morbidity and mortality. For patients in whom systemic sepsis is absent or well controlled, minimal access techniques, such as endoscopic therapies, are being increasingly employed to reduce the morbidity of surgical re-intervention. In this review, we aim to assess the utility of endoscopic management in the acute setting of colorectal anastomotic complications, focusing on anastomotic leak.MethodA literature search was performed for published full text articles using the PubMed, Cochrane and Scopus databases using the search criteria string colorectal anastomotic (leak OR bleed), endoscopy, endoscopic management. Additional papers were detected by scanning the references of relevant papers. Data were extracted from each study by two authors onto a dedicated pro-forma. Given the nature of the data extracted, no meta-analysis was performed.ResultsA total of 89 papers were identified, 16 of which were included in this review; an additional 14 papers were obtained from reference searches. In patients who are not physiologically compromised, there are promising data regarding the salvage rate of stents, over-the-scope endoscopic clips, vacuum therapy and fibrin glue in the early management of colorectal anastomotic leak. There is no consensus regarding the optimal approach, and data to assist the physician in patient selection are lacking. Whilst data on salvage (i.e. healing and avoidance of surgery) are well understood, no data on functional outcomes are reported.ConclusionEndoscopic therapy in the management of stable patients with colorectal anastomotic leaks appears safe and in selected patients is associated with high rates of technical success. Challenges remain in selecting the most appropriate strategy, patient selection, and understanding the functional and long-term sequelae of this approach. Further evidence from large prospective cohort studies are needed to further evaluate the role of these novel strategies.
引用
收藏
页码:1049 / 1065
页数:17
相关论文
共 55 条
[1]  
Abbas MA, 2009, JSLS-J SOC LAPAROEND, V13, P420
[2]   Modern Treatments and Stem Cell Therapies for Perianal Crohn's Fistulas [J].
Al-Maawali, Alghalya Khalid Sulaiman ;
Phuong Nguyen ;
Phang, P. Terry .
CANADIAN JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, 2016, 2016
[3]   From iatrogenic digestive perforation to complete anastomotic disunion: endoscopic stenting as a new concept of "stent-guided regeneration and re-epithelialization" [J].
Amrani, Laila ;
Menard, Charles ;
Berdah, Stephane ;
Emungania, Olivier ;
Soune, Phillipe Ah ;
Subtil, Clement ;
Brunet, Christian ;
Grimaud, Jean-Charles ;
Barthet, Marc .
GASTROINTESTINAL ENDOSCOPY, 2009, 69 (07) :1282-1287
[4]   Endoluminal vacuum therapy for anastomotic leaks after rectal surgery [J].
Arezzo, A. ;
Miegge, A. ;
Garbarini, A. ;
Morino, M. .
TECHNIQUES IN COLOPROCTOLOGY, 2010, 14 (03) :279-281
[5]  
Arezzo A, 2017, SURG ENDOSC
[6]   Efficacy of the over-the-scope clip (OTSC) for treatment of colorectal postsurgical leaks and fistulas [J].
Arezzo, Alberto ;
Verra, Mauro ;
Reddavid, Rossella ;
Cravero, Francesca ;
Bonino, Marco Augusto ;
Morino, Mario .
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 2012, 26 (11) :3330-3333
[7]   Vacuum-assisted closure: A new method for wound control and treatment: Clinical experience [J].
Argenta, LC ;
Morykwas, MJ .
ANNALS OF PLASTIC SURGERY, 1997, 38 (06) :563-576
[8]   Consequences of Anastomotic Leak After Restorative Proctectomy for Cancer: Effect on Long-term Function and Quality of Life [J].
Ashburn, Jean H. ;
Stocchi, Luca ;
Kiran, Ravi P. ;
Dietz, David W. ;
Remzi, Feza H. .
DISEASES OF THE COLON & RECTUM, 2013, 56 (03) :275-280
[9]   Management of postoperative bleeding after laparoscopic left colectomy [J].
Besson, Romain ;
Christidis, Christos ;
Denet, Christine ;
Bruyns, Laurence ;
Levard, Hugues ;
Gayet, Brice ;
Fuks, David ;
Perniceni, Thierry .
INTERNATIONAL JOURNAL OF COLORECTAL DISEASE, 2016, 31 (08) :1431-1436
[10]   Use of transanastomotic double-pigtail stents in the management of grade B colorectal leakage: a pilot feasibility study [J].
Blot, Christelle ;
Sabbagh, Charles ;
Rebibo, Lionel ;
Brazier, Franck ;
Chivot, Cyril ;
Fumery, Mathurin ;
Regimbeau, Jean-Marc .
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 2016, 30 (05) :1869-1875