COLORECTAL SURGERY

Surgical management and long-term functional outcomes after anastomotic leak in patients undergoing minimally invasive restorative rectal resection and without a diverting ileostomy

Tony McGiffin BSc, MD

Departmentt of Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

Contribution: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Validation, Visualization, Writing - original draft, Writing - review & editing

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David A. Clark MBBS, FRACS, FRCSEd,

Corresponding Author

David A. Clark MBBS, FRACS, FRCSEd

[email protected]

orcid.org/0000-0002-2065-3012

Departmentt of Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia

Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia

Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia

Correspondence

Professor David A. Clark, St Vincent's Private Hospital Northside, 627 Rode Road, Chermside, 4032, Brisbane. QLD, Australia.

Email: [email protected]

Contribution: Conceptualization, Data curation, Investigation, Methodology, Project administration, Resources, Validation, Visualization, Writing - original draft, Writing - review & editing

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Aleks Edmundson PhD,

Aleks Edmundson PhD

Departmentt of Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia

Contribution: Data curation, Methodology, Project administration, Writing - review & editing

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Daniel Steffens PhD,

Daniel Steffens PhD

orcid.org/0000-0002-9715-860X

Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia

Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia

Contribution: Data curation, Methodology, Project administration, Resources, Software, Supervision, Visualization, Writing - original draft, Writing - review & editing

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Andrew Stevenson MBBS, FRACS,

Andrew Stevenson MBBS, FRACS

Departmentt of Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia

Contribution: Project administration, Resources, Writing - review & editing

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Michael Solomon MBBCH (Hons), BAO, MSc (Tor), DMedSc (USYD),

Michael Solomon MBBCH (Hons), BAO, MSc (Tor), DMedSc (USYD)

orcid.org/0000-0002-5602-6045

Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia

Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia

Contribution: Conceptualization, Methodology, Project administration, Software, Supervision, Visualization, Writing - review & editing

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Tony McGiffin BSc, MD,

Tony McGiffin BSc, MD

Departmentt of Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

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David A. Clark MBBS, FRACS, FRCSEd,

Corresponding Author

David A. Clark MBBS, FRACS, FRCSEd

[email protected]

orcid.org/0000-0002-2065-3012

Departmentt of Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia

Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia

Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia

Correspondence

Professor David A. Clark, St Vincent's Private Hospital Northside, 627 Rode Road, Chermside, 4032, Brisbane. QLD, Australia.

Email: [email protected]

Contribution: Conceptualization, Data curation, Investigation, Methodology, Project administration, Resources, Validation, Visualization, Writing - original draft, Writing - review & editing

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Aleks Edmundson PhD,

Aleks Edmundson PhD

Departmentt of Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia

Contribution: Data curation, Methodology, Project administration, Writing - review & editing

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Daniel Steffens PhD,

Daniel Steffens PhD

orcid.org/0000-0002-9715-860X

Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia

Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia

Contribution: Data curation, Methodology, Project administration, Resources, Software, Supervision, Visualization, Writing - original draft, Writing - review & editing

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Andrew Stevenson MBBS, FRACS,

Andrew Stevenson MBBS, FRACS

Departmentt of Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia

Contribution: Project administration, Resources, Writing - review & editing

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Michael Solomon MBBCH (Hons), BAO, MSc (Tor), DMedSc (USYD),

Michael Solomon MBBCH (Hons), BAO, MSc (Tor), DMedSc (USYD)

orcid.org/0000-0002-5602-6045

Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia

Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia

Contribution: Conceptualization, Methodology, Project administration, Software, Supervision, Visualization, Writing - review & editing

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First published: 24 January 2022

https://doi.org/10.1111/ans.17475

Citations: 4

T. McGiffin BSc, MD; David A. Clark MBBS, FRACS, FRCSEd; Aleks Edmundson PhD; Daniel Steffens PhD; Andrew Stevenson MBBS, FRACS; Michael Solomon MBBCH (Hons), BAO, MSc (Tor), DMedSc (USYD).

The corresponding author is not the recipient of a research scholarship and is not a registrar in training.

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Abstract

Background

Anastomotic leak (AL) is the anathema of colorectal surgery, with well-documented adverse impacts on patient morbidity and mortality. The long-term consequences of AL on bowel function and quality of life (QoL) is less well-defined after minimally invasive surgery. By omitting a temporary diverting ileostomy (TDI), it is postulated that the minimally invasive approach will lead to early diagnosis and expedient management of AL.

Methods

This retrospective and cross-sectional study included patients who underwent minimally invasive restorative rectal surgery with a low pelvic colorectal anastomosis and without a TDI at two tertiary hospitals in Brisbane, Australia between 2004 and 2018. Surgical management of AL is described and long-term functional outcomes were evaluated through validated questionnaires.

Results

Two hundred and twenty-four patients met inclusion criteria. AL was associated with lesion proximity to the anal verge (P = 0.011), total mesorectal excision (TME) (P <0.001) and advanced malignant disease (P = 0.019). Twenty-four patients experienced an AL (11%) diagnosed at a median of 5.5 days post-operative. Survey responders (n = 99, 62%) included 10 (10%) AL and 89 (90%) non-AL patients, with a median follow-up of 4 and 6.4 years. SF-36 and FISI scores were comparable between groups, however AL patients had worse LARS scores (P = 0.028). Patients undergoing TME, irrespective of AL, had poorer low anterior resection syndrome (LARS) (P <0.001) and FISI scores (P = 0.001).

Conclusion

AL in patients undergoing minimally invasive low pelvic colorectal anastomosis without a TDI does not impact long term QoL. The occurrence of LARS is dependent on the extent of resection, rather than the occurrence of AL.

Conflict of interest

None declared.

Open Research

Data availability statement

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

Supporting Information

References

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Volume92, Issue4

April 2022

Pages 806-812

Surgical management and long-term functional outcomes after anastomotic leak in patients undergoing minimally invasive restorative rectal resection and without a diverting ileostomy

Abstract

Background

Methods

Results

Conclusion

Conflict of interest

Open Research

Data availability statement

Supporting Information

References

Citing Literature

References

Information

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Surgical management and long-term functional outcomes after anastomotic leak in patients undergoing minimally invasive restorative rectal resection and without a diverting ileostomy

Abstract

Background

Methods

Results

Conclusion

Conflict of interest

Open Research

Data availability statement

Supporting Information

References

Citing Literature

References

Related

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