Marco E Allaix, MD, PhD, Adriana Lena, MD, Maurizio Degiuli, MD, Alberto Arezzo, MD, Massimiliano Mistrangelo, MD, PhD, Mario Morino, MD. Department of Surgical Sciences, University of Torino
INTRODUCTION: The evidence supporting the use of the air leak test (ALT) after laparoscopic left-sided colon resection (LLCR) to test the colorectal anastomosis (CA) integrity aiming at reducing the rate of postoperative CA leakage (CAL) is not conclusive. The aim of this study was to challenge the use of ALT after elective LLCR.
METHODS AND PROCEDURES: It is a retrospective analysis of a prospectively collected database including all patients undergoing elective LLCR with primary CA and no proximal bowel diversion for sigmoid diverticulitis, large colon adenomas and cancer between January 1996 and June 2017. The surgical technique was standardized, with intracorporeal sigmoid mesocolon dissection, inferior mesenteric vessels division, and distal sigmoid colon/upper rectum transection by a laparoscopic linear stapler. The bowel was then exteriorized through a protected suprapubic incision, the descending colon was divided and the anvil of a circular stapler introduced into the lumen of the proximal colon. The colon was then returned to the abdomen and a laparoscopic transanal intracorporeal double-stapled colorectal anastomosis was performed. The decision to perform the ALT was based on the individual surgeon routine practice. A multivariate analysis was performed to identify independent risk factors for CAL.
RESULTS: A total of 777 LLCR without proximal diversion were included in the analysis: the CA was tested in 398 patients (ALT group), while intraoperative ALT was not performed in 379 patients (No-ALT group). The two groups of patients were similar in demographic data, indication for surgery and type of procedure. Intraoperative CAL was detected in 20 (5%) ALT patients: a stoma was created in 14 (70%) patients, while 6 (30%) patients had a suture repair alone. Overall, postoperative CAL occurred in 32 patients (4.1%): the postoperative CAL rate was lower in ALT patients than in No-ALT patients (2.5% vs. 5.8%, P=0.025). A reoperation was needed in 87.5% of cases. No CAL occurred in the 20 patients with intraoperative positive ALT. Multivariate analysis showed that ASA score 3 (HR 8.80, 95% CI 2.57-30.15, P=0.001) and male sex (HR 3.87, 95% CI 1.63-9.16, P=0.002) were independent risk factors for postoperative CAL, while intraoperative ALT independently reduced the postoperative CAL rate (HR 0.41, 95% CI 0.19-0.89, P=0.030).
CONCLUSION: Intraoperative ALT allows to detect AL defects after LLCR that can be effectively managed intraoperatively, leading to a significant lower risk of postoperative CAL.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86417
Program Number: S033
Presentation Session: Colorectal 1 Session
Presentation Type: Podium