Rennie Olivia, Sharma Manaswi, Helwa Nour
Department of Clinical Affairs, FluidAI Medical (Formerly NERv Technology Inc.), Kitchener, ON, Canada.
Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Front Surg. 2024 May 2;11:1371567. doi: 10.3389/fsurg.2024.1371567. eCollection 2024.
Anastomotic leaks (ALs) are a significant and feared postoperative complication, with incidence of up to 30% despite advances in surgical techniques. With implications such as additional interventions, prolonged hospital stays, and hospital readmission, ALs have important impacts at the level of individual patients and healthcare providers, as well as healthcare systems as a whole. Challenges in developing unified definitions and grading systems for leaks have proved problematic, despite acknowledgement that colorectal AL is a critical issue in intestinal surgery with serious consequences. The aim of this study was to construct a narrative review of literature surrounding definitions and grading systems for ALs, and consequences of this postoperative complication.
A literature review was conducted by examining databases including PubMed, Web of Science, OVID Embase, Google Scholar, and Cochrane library databases. Searches were performed with the following keywords: anastomosis, anastomotic leak, colorectal, surgery, grading system, complications, risk factors, and consequences. Publications that were retrieved underwent further assessment to ensure other relevant publications were identified and included.
A universally accepted definition and grading system for ALs continues to be lacking, leading to variability in reported incidence in the literature. Additional factors add to variability in estimates, including differences in the anastomotic site and institutional/individual differences in operative technique. Various groups have worked to publish guidelines for defining and grading AL, with the International Study Group of Rectal Cancer (ISGRC/ISREC) definition the current most recommended universal definition for colorectal AL. The burden of AL on patients, healthcare providers, and hospitals is well documented in evidence from leak consequences, such as increased morbidity and mortality, higher reoperation rates, and increased readmission rates, among others.
Colorectal AL remains a significant challenge in intestinal surgery, despite medical advancements. Understanding the progress made in defining and grading leaks, as well as the range of negative outcomes that arise from AL, is crucial in improving patient care, reduce surgical mortality, and drive further advancements in earlier detection and treatment of AL.
吻合口漏是一种严重且令人担忧的术后并发症，尽管手术技术有所进步，但其发生率仍高达30%。吻合口漏会引发额外干预、延长住院时间及再次入院等问题，对个体患者、医疗服务提供者以及整个医疗系统都产生重大影响。尽管人们认识到结直肠吻合口漏是肠道手术中的关键问题且后果严重，但制定统一的漏诊定义和分级系统仍面临挑战。本研究的目的是对有关吻合口漏的定义、分级系统以及这种术后并发症后果的文献进行叙述性综述。
通过检索包括PubMed、科学网、OVID Embase、谷歌学术和Cochrane图书馆数据库在内的数据库进行文献综述。检索词如下：吻合术、吻合口漏、结直肠、手术、分级系统、并发症、危险因素及后果。对检索到的出版物进行进一步评估，以确保识别并纳入其他相关出版物。
目前仍缺乏一个被普遍接受的吻合口漏定义和分级系统，这导致文献报道的发生率存在差异。其他因素也增加了估计的变异性，包括吻合部位的差异以及手术技术方面的机构/个体差异。多个组织致力于发布吻合口漏的定义和分级指南，国际直肠癌研究组（ISGRC/ISREC）的定义是目前最推荐的结直肠吻合口漏通用定义。吻合口漏对患者、医疗服务提供者和医院造成的负担在漏诊后果的证据中得到了充分记录，如发病率和死亡率增加、再次手术率升高以及再入院率增加等。
尽管医学取得了进步，但结直肠吻合口漏仍是肠道手术中的重大挑战。了解在定义和分级漏诊方面取得的进展以及吻合口漏产生的一系列负面结果，对于改善患者护理、降低手术死亡率以及推动吻合口漏早期检测和治疗的进一步发展至关重要。
