Angeramo Cristian A, Dreifuss Nicolas H, Schlottmann Francisco, Bun Maximilano E, Rotholtz Nicolas A
Department of Surgery, Hospital Alemán de Buenos Aires, 1640 Pueyrredon Ave, Capital Federal, Buenos Aires, Argentina.
Division of Colorectal Surgery, Hospital Alemán de Buenos Aires, Buenos Aires, Argentina.
Updates Surg. 2020 Jun;72(2):463-468. doi: 10.1007/s13304-020-00754-1. Epub 2020 Apr 13.
Anastomotic leak (AL) is the most feared complication after colorectal surgery and time to diagnosis is variable. The aim of this study was to analyze the outcomes of patient who had an AL during or after hospital discharge. A retrospective analysis of a prospectively collected database of all patients undergoing laparoscopic colorectal resections without proximal diversion during the period 2008-2018 was conducted. The sample was divided into two groups: patients who had AL during hospitalization (G1) and those who had AL after hospital discharge (G2). Demographics, operative variables and postoperative outcomes were compared between groups. A total of 853 patients were included; AL was diagnosed in 60 (7%) patients and was more frequent during initial hospitalization than after hospital discharge (G1: 49 (82%) vs. G2: 11 (18%), p < 0.001). Demographics were similar between groups. Most patients were treated with laparoscopic lavage and diverting ileostomy in both groups (G1: 92% vs. G2: 82%, p = 0.30). Severity of peritonitis at reoperation and length of hospital stay after AL were similar between groups (G1: 11 vs. G2: 9 days, p = 0.54). Overall postoperative morbidity (G1: 57% vs. G2: 36%, p = 0.31), mortality (G1: 10% vs. G2: 27%, p = 0.15) and intestinal reconstruction rate (G1: 92% vs. G2: 100%, p = 1) were similar between groups. Outpatient onset of anastomotic leak did not increase the severity of peritonitis, had no impact on the type of treatment performed, and showed similar postoperative morbidity and mortality as compared to those having AL during hospitalization.
吻合口漏（AL）是结直肠手术后最令人担忧的并发症，诊断时间各不相同。本研究的目的是分析在住院期间或出院后发生吻合口漏的患者的结局。对2008年至2018年期间所有接受腹腔镜结直肠切除术且未进行近端转流的患者的前瞻性收集数据库进行了回顾性分析。样本分为两组：住院期间发生吻合口漏的患者（G1组）和出院后发生吻合口漏的患者（G2组）。比较两组之间的人口统计学、手术变量和术后结局。共纳入853例患者；60例（7%）患者被诊断为吻合口漏，且在初次住院期间比出院后更常见（G1组：49例（82%） vs. G2组：11例（18%），p＜0.001）。两组之间的人口统计学相似。两组中大多数患者均接受了腹腔镜灌洗和转流性回肠造口术治疗（G1组：92% vs. G2组：82%，p = 0.30）。再次手术时腹膜炎的严重程度以及吻合口漏后住院时间在两组之间相似（G1组：11天 vs. G2组：9天，p = 0.54）。总体术后发病率（G1组：57% vs. G2组：l36%，p = 0.31）、死亡率（G1组：10% vs. G2组：27%，p = 0.15）和肠道重建率（G1组：92% vs. G2组：100%，p = 1）在两组之间相似。门诊发生吻合口漏并未增加腹膜炎的严重程度，对所进行的治疗类型没有影响，并且与住院期间发生吻合口漏的患者相比，术后发病率和死亡率相似。
