Review
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World J Gastrointest Surg. Feb 27, 2014; 6(2): 14-26
Published online Feb 27, 2014. doi: 10.4240/wjgs.v6.i2.14
Prediction and diagnosis of colorectal anastomotic leakage: A systematic review of literature
Freek Daams, Zhouqiao Wu, Max Jef Lahaye, Johannus Jeekel, Johan Frederik Lange
Freek Daams, Department of Surgery, Catharina Ziekenhuis, Postbus 1350, 5602 ZA Eindhoven, The Netherlands
Freek Daams, Zhouqiao Wu, Johan Frederik Lange, Department of Surgery, Erasmus Medical Center, Postbus 2040, 3000 CA Rotterdam, The Netherlands
Max Jef Lahaye, Department of Radiology, Maastricht University Medical Centre, Postbus 5800, 6202 AZ Maastricht, The Netherlands
Johan Frederik Lange, Department of Neuroscience, Erasmus Medical Center, Postbus 2040, 3000 CA Rotterdam, The Netherlands
Author contributions: Daams F, Wu Z, Jeekel J and Lange JF designed the paper; Daams F and Wu Z performed data acquisition; Daams F, Wu Z, Lahaye MJ, Jeekel J and Lange JF analysed and interpreted the data; Daams F, Wu Z, Lahaye MJ, Jeekel J and Lange JF drafted the article; Daams F, Wu Z and Lahaye MJ wrote the paper; Jeekel J and Lange JF approved of the paper.
Correspondence to: Freek Daams, MD, Department of Surgery, Erasmus Medical Center, Secretariaat Chirurgie, ErasmusMC, Postbus 2040, 3000 CA Rotterdam, The Netherlands. freek.daams@cze.nl
Telephone: +31-10-7043683 Fax: +31-10-7044746
Received: September 10, 2013
Revised: October 30, 2013
Accepted: January 13, 2014
Published online: February 27, 2014
Processing time: 190 Days and 5.7 Hours
Abstract

Although many studies have focused on the preoperative risk factors of anastomotic leakage after colorectal surgery (CAL), postoperative delay in diagnosis is common and harmful. This review provides a systematic overview of all available literature on diagnostic tools used for CAL. A systematic search of literature was undertaken using Medline, Embase, Cochrane and Web-of-Science libraries. Articles were selected when a diagnostic or prediction tool for CAL was described and tested. Two reviewers separately assessed the eligibility and level of evidence of the papers. Sixty-nine articles were selected (clinical methods: 11, laboratory tests: 12, drain fluid analysis: 12, intraoperative techniques: 22, radiology: 16). Clinical scoring leads to early awareness of probability of CAL and reduces delay of diagnosis. C-reactive protein measurement at postoperative day 3-4 is helpful. CAL patients are characterized by elevated cytokine levels in drain fluid in the very early postoperative phase in CAL patients. Intraoperative testing using the air leak test allows intraoperative repair of the anastomosis. Routine contrast enema is not recommended. If CAL is clinically suspected, rectal contrast-computer tomography is recommended by a few studies. In many studies a “no-test” control group was lacking, furthermore no golden standard for CAL is available. These two factors contributed to a relatively low level of evidence in the majority of the papers. This paper provides a systematic overview of literature on the available tools for diagnosing CAL. The study shows that colorectal surgery patients could benefit from some diagnostic interventions that can easily be performed in daily postoperative care.

Keywords: Colorectal; Anastomosis; Leakage; Diagnosis; Prediction

Core tip: Postoperative delay in diagnosis of colorectal anastomotic leakage is common and harmful. This paper provides a systematic overview of literature on the available tools for diagnosing colorectal surgery. The study shows that colorectal surgery patients could benefit from some diagnostic interventions that can easily be performed in daily postoperative care.