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Factors determining delay in relaparotomy for anastomotic leakage after colorectal resection

World Journal of Gastroenterology 2007年第27期13卷 3721-3725页

作者： A Doeksen PJ Tanis BC Vrouenraets JJB Lanschot van WF Tets van Department of Surgery Sint Lucas Andreas Hospital Jan Tooropstraat 164 1006 AE Amsterdam The Netherlands Department of Surgery Academic Medical Center Meibergdreef 9 1100 DD Amsterdam The Netherlands Department of Surgery Sint Lucas Andreas Hospital Jan Tooropstraat 164 1006 AE Amsterdam The Netherlands Department of Surgery Academic Medical Center Meibergdreef 9 1100 DD Amsterdam The Netherlands

AIM： To analyze the time interval （‘delay＇） between the first occurrence of clinical parameters associated with anastomotic leakage alter colorectal resection and subsequent relaparotomy. METHODS： In 36 out of 289 consecutive patients with colorectal anastomosis, leakage was confirmed at relaparotomy. The medical records of these patients were retrospectively analysed and type and time of appearance of clinical parameters suggestive of anastomotic leakage were recorded. These parameters included heart rate, body temperature, local or generalized peritoneal reaction, leucocytosis, ileus and delayed gastric emptying. Factors influencing delay of relaparotomy and consequences of delayed recognition and treatment were determined. RESULTS： First documentation of at least one of the predefined parameters for anastomotic leakage was alter a median interval of 4 ± 1.7 d alter the operation. The median number of days between first parameter（s） associated with leakage and relaparotomy was 3.5 ± 5.7 d. The time interval between the first signs of leakage and relaparotomy was significantly longer when a weekend was included （4.2 d vs 2.4 d, P = 0.021） or radiological evaluation proved to be false-negative （8.1 d vs 3.5 d, P = 0.007）. No significant association between delay and number of additional relaparotomies, hospital stay or mortality could be demonstrated.CONCLUSION： An intervening weekend and negative diagnostic imaging reports may contribute to a delay in diagnosis and relaparotomy for anastomotic leakage. That delay was more than two days in two-thirds of the patients.

关键词： Colorectal surgery Anastomosis Leakage clinical parameter Delay

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