Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Klinikum Leverkusen gGmbH, Am Gesundheitspark 11, 51375, Leverkusen, Germany.
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany.
Langenbecks Arch Surg. 2020 Mar;405(2):223-232. doi: 10.1007/s00423-020-01864-5. Epub 2020 Mar 18.
Anastomotic leakage is one of the most worrisome complications in colorectal surgery. An expert meeting was organized to discuss and find a consensus on various aspects of the surgical management of colorectal disease with a possible impact on anastomotic leakage.
A three-step Delphi-method was used to find consensus recommendations.
Strong consensus was achieved for the use of mechanical bowel preparation and oral antibiotics prior to colorectal resections, the abundance of non-selective NSAIDs, the preoperative treatment of severe iron deficiency anemia, and for attempting to improve the patients' general performance in the case of frailty. Concerning technical aspects of rectal resection, there was a strong consensus in regard to routinely mobilizing the splenic flexure, to dividing the inferior mesenteric vein, and to using air leak tests to check anastomotic integrity. There was also a strong consensus on not to oversew the stapled anastomoses routinely, to use protective ileostomies for low rectal and intersphincteric, but not for high-rectal anastomoses. Furthermore, a consensus was reached in regard to using CT-scans with rectal contrast enema to evaluate suspected anastomotic leakage as well as measuring C-reactive protein routinely to monitor the postoperative course after colorectal resections. No consensus was found concerning the indication and technique for testing bowel perfusion, the routine use of endoscopy to check the integrity of the anastomosis, the placement of transanal drains for rectal anastomoses and the management of anastomotic leakage with peritonitis.
Consensus could be found for several practice details in the perioperative management in colorectal surgery that might have an influence on anastomotic leakage.
吻合口漏是结直肠手术中最令人担忧的并发症之一。为了讨论和寻找共识，专家会议专门针对可能影响吻合口漏的结直肠疾病的手术管理的各个方面进行了组织。
采用三步德尔菲法寻找共识建议。
在结直肠切除术前使用机械肠道准备和口服抗生素、非选择性 NSAIDs 的使用、术前严重缺铁性贫血的治疗以及尝试改善虚弱患者的一般状况方面，达成了强烈共识。在直肠切除的技术方面，常规游离脾曲、肠系膜下静脉的分离以及使用气漏试验检查吻合口完整性方面，达成了强烈共识。对于吻合口的缝合，也达成了强烈共识，即不常规缝合吻合口，对于低位直肠和内外括约肌间的吻合，使用保护性回肠造口术，但对于高位直肠吻合，则不使用。此外，还就使用直肠对比造影 CT 扫描评估疑似吻合口漏以及常规测量 C 反应蛋白监测结直肠切除术后的术后过程达成了共识。对于肠灌注的检测指征和技术、常规内镜检查吻合口完整性、直肠吻合的经肛门引流管放置以及腹膜炎时吻合口漏的处理，未达成共识。
在结直肠手术围手术期管理中，对于可能影响吻合口漏的几个具体操作，可以达成共识。
