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oai:tsukuba.repo.nii.ac.jp:00054825
2022-04-27T09:29:09Z
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3:62:5297:7987
Exploring optimal examination to detect occult anastomotic leakage after rectal resection in patients with diverting stoma
榎本, 剛史
エノモト, ツヨシ
ENOMOTO, Tsuyoshi
大原, 佑介
オオハラ, ユウスケ
OHARA, Yusuke
大和田, 洋平
オオワダ, ヨウヘイ
OWADA, Yohei
久倉, 勝治
ヒサクラ, カツジ
HISAKURA, Katsuji
明石, 義正
アカシ, ヨシマサ
AKASHI, Yoshimasa
高橋, 一広
タカハシ, カズヒロ
TAKAHASHI, Kazuhiro
小川, 光一
オガワ, コウイチ
OGAWA, Koichi
下村, 治
シモムラ, オサム
SHIMOMURA, Osamu
小田, 竜也
オダ, タツヤ
ODA, Tatsuya
Kitaguchi, Daichi
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Background
When considering “early stoma closure”, both standardized inclusion/exclusion criteria and standardized methods to assess anastomosis are necessary to reduce the risk of occult anastomotic leakage (AL). However, in the immediate postoperative period, neither have the incidence and risk factors of occult AL in patients with diverting stoma (DS) been clarified nor have methods to assess anastomosis been standardized. The aim of this study was to elucidate the incidence and risk factors of occult AL in patients who had undergone rectal resection with DS and to evaluate the significance of computed tomography (CT) following water-soluble contrast enema (CE) to detect occult anastomotic leakage.
Methods
This was a single institutional prospective observational study of patients who had undergone rectal resection with the selective use of DS between May and October 2019. Fifteen patients had undergone CE and CT to assess for AL on postoperative day (POD) 7, and CT was performed just after CE. Univariate analysis was performed to assess the relationship between preoperative variables and the incidence of occult AL on POD 7.
Results
The incidence of occult AL on postoperative day 7 was 6 of 15 (40%). Hand-sewn anastomosis, compared with stapled anastomosis, was a significant risk factor. Five more cases with occult AL that could not be detected with CE could be detected on CT following CE; CE alone had a 33% false-negative radiological result rate.
Conclusions
Hand-sewn anastomosis appeared to be a risk factor for occult AL, and CE alone had a high false-negative radiological result rate. When considering the introduction of early stoma closure, stapled anastomosis and CT following CE could be an appropriate inclusion criterion and preoperative examination, respectively.
BioMed Central
2020-03
eng
journal article
http://hdl.handle.net/2241/00160234
https://tsukuba.repo.nii.ac.jp/records/54825
32192490
10.1186/s12893-020-00706-x
1471-2482
AA1203545X
BMC surgery
20
53
https://tsukuba.repo.nii.ac.jp/record/54825/files/BMCS_20-53.pdf
application/pdf
655.4 kB
2020-06-26