Prediction and diagnosis of colorectal anastomotic leakage: A systematic review of literature

Table 4 Intra-operative techniques

Author	Type of study	Loe	n (CAL/non-CAL	Colorectal/rectum	Stapled/handsewn anastomosis	Test	Testper-formed	Test +	Intra-operative correction	CAL test+	Test -	CAL test-	Test not per-formed	CALtest not per-formed	Mainoutcome
Beard et al[43]	Pro	1b	13/145	Colorectal	Both	ALT	73	18	18	3	55	0	70	10	ALT and preoperative repair reduce risk of AL
Davies et al[44]	Pro	3b	4/33	Rectum	?	ALT	33	6	6	1	27	3	-	-	LT helpful to reduce leakage rate
Dixon et al[45]	Retro	3b	2/202	Rectum	Both	ALT	119	5	5	0	114	0	-	-	Leaks were avoided
Gilbert et al[46]	Retro	3b	1/21	Colorectal	Handsewn	ALT	21	5	5	1	16	0	-	-	ALT facilitates IOR
Lazorthes et al[47]	Pro	3b	3/82	Colorectal	Stapled, doughnut complete 68	ALT	68	0	0	0	68	3	-	-	High NPV for ALT
					Stapled, doughnut incomplete 14		14	4	4	0	10	0	-	-
Ricciardi et al[48]	Retro	3b	48/998	Colorectal	Both	ALT	825	65	65	5	760	29	173	14	ALT for leftsided anastomosis
Schmidt et al[49]	Pro	3b	68/933	Rectum	Both	ALT	260	47	42	5	213	22	36	4	Risk of AL is unrelated to ALT
Wheeler et al[50]	Pro	4	7/102	Colorectal	?	ALT	99	21	21	2	85	2	-	-	LT facilitates IOR
Yalin et al[51]	Po	3b	1/23	Colo-rectal	Stapled	ALT	21	5	5	1	16	0	-	-	LT facilitates IOR
Griffith et al[54]	Pro	4	2/60	Colorectal	Stapled	ALT	60	11	11	0	49	2	-	-	ALT facilitates IOR
Sakanoue et al[55]	Pro	3b	4/70	Rectum	?	ALT	35	2	2	0	33	0	35	4	Useful for intraoperative decision making
Smith et al[53]	Pro	4	7/229	Colon	Both	ALT	229	16	16	0	213	7	-	-	After IOR no CAL occurred
Lanthaler et al[56]	Pro	3b	6/122	Colorectal	Stapled	IOE	73	5	5	0	68	4	49	2	ALT prevents early leak
Li et al[57]	Pro	3b	2/244	Rectum	Stapled	IOE	107	11	11	0	96	0	137, 30 IOC1	2/137, 1/30	Routine IOE and selective IOE equal results
Shamiyeh et al[58]	Pro	3b	7/253	Rectum	Stapled	IOE	85	2	2	0	83	1	253	4	Routine IOE does not reduce CAL
Ishihara et al[52]	Pro	4	1/73	Rectum	Stapled	IOE and ALT	73	4	4	0	69	1	-	-	ALT recommended
Ambrosetti et al[59]	Pro	4	2/200	Colorectal	Both	Doppler ultra-sound									Doppler facilitates IOR
Vignali et al[60]	Pro	3b	8/55	Colorectal	Stapled	Laser doppler	-	-	-	-	-	-	-	-	Reduction in microperfusion increases risk of CAL
Kudszus et al[61]	Retro	3b	22/402	Colorectal	Both	LFA	201	28	28	8	-	-	201	15	LFA reduces reoperation rate for AL, most prominent in handsewn
Hirano et al[62]	Pro	4	1/20	Colorectal	?	Near infrared spectro-scopy									StO2 < 60% in CAL
Novell et al[64]	Pro	3b	275	Colorectal	Both	Obser-vation of marginal artery bleeding									Pulsatile flow: lower incidence CAL
Sheridan et al[65]	Pro	3b	5/50	Colon	?	Tissue pO2 measurement									Reduced anastomotic pO2 predictive CAL
Karliczek et al[63]	Pro	3b	14/77	Colorectal	?	Visible light spectro-scopy									pO2 could predict CAL

¹Indicated by the surgeon. Pro: Prospective; Retro: Retrospective; Exp: Experimental (model); Loe: Level of evidence; CAL: Colorectal anastomotic leakage; ALT: Air or methylene blue leak test; IOC: Intra-operative endoscopy; LFA: Laser fluorescence angiography; IOR: Intra-operative repair; NPV: Negative predictive value.