Abstract
The predictive value and safety of early postoperative radiological assessment of colorectal anastomotic integrity is controversial. In this study, 233 patients with colorectal or left sided colonic anastomoses had water soluble contrast enemas performed in the early postoperative period (mean: day 7 postoperatively, range: days 4–14). A total of 40 radiological leaks were recorded but only 12 of these patients had clinical signs of anastomotic dehiscence. Furthermore, 11 patients who had normal contrast enemas subsequently developed a clinical anastomotic leak. There were therefore 28 (12.0%) false positive and 11 (4.7%) false negative results giving values for the specificity and sensitivity of the radiological investigation of 86.7% and 52.2% respectively. Only 3 patients (1.3%) developed a clinically apparent anastomotic complication following a contrast enema. We conclude that while radiological assessment of distal large bowel anastomoses in the early postoperative period appears to be a safe procedure, it provides little useful clinical information with regard to early postoperative morbidity. Recent work has, however, suggested that radiological anastomotic integrity may be relevant to long term outcome following surgery for colorectal cancer.
Résumé
La valeur prédictive et la sécurité d'un contrôle radiologique post-opératoire précoce de l'intégrité d'une anastomose colo-rectale est controversée. Dans cette étude 233 malades avec des anastomoses colo-rectales ou coliques gauches ont eu un lavement baryté aux hydrosolubles exécuté dans la période post-opératoire précoce (moyenne: 7 jours, écart: 4–14). Un total de 40 fistules radiologiques étaient enregistrées mais seulement 12 de ces malades avaient des signes cliniques de fistule anastomotique. De plus 11 malades qui avaient un lavement normal ont développé ultérieurement une fistule anastomotique clinique. Il y a eu par conséquent 28 (12%) faux positifs et 11 (4,7%) faux négatifs avec donc une spécificité et une sensitivité de l'examen radiologique respectivement de 86,7% et de 52,2%. Seuls 3 malades (1,3%) ont développé une complication anastomotique évidente après un lavement baryté. Nous concluons que tandis que l'examen radiologique des anastomoses sur le colon distal dans la période post-opératoire précoce semble être un procédé sur, il fournit peu d'indication utile en ce qui concerne la morbidité post-opératoire précoce. Un travail récent toutefois suggère que l'intégrité anastomotique radiologique peut être en relation avec l'évolution à long terme après chirurgie pour cancer colo-rectal.
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Akyol, A.M., McGregor, J.R., Galloway, D.J. et al. Early postoperative contrast radiology in the assessment of colorectal anastomotic integrity. Int J Colorect Dis 7, 141–143 (1992). https://doi.org/10.1007/BF00360354
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DOI: https://doi.org/10.1007/BF00360354