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首页> 外文期刊>Surgical Endoscopy >Intraoperative air leak test reduces the rate of postoperative anastomotic leak: analysis of 777 laparoscopic left-sided colon resections
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Intraoperative air leak test reduces the rate of postoperative anastomotic leak: analysis of 777 laparoscopic left-sided colon resections

机译：术中空气泄漏试验降低了术后吻合液泄漏的速率：777腹腔镜左侧结肠切除分析

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Background 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 It is a retrospective analysis of a prospectively collected database including all patients undergoing elective LLCR with primary CA and no proximal bowel diversion between January 1996 and June 2017. 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 were similar in demographic characteristics, indication, and type of procedure. Intraoperative ALT was positive in 20 (5%) 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 (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 3-4 (OR 5.39, 95% CI 2.53-11.51,p <0.001) and male sex (OR 3.96, 95% CI 1.66-9.43, p = 0.002) were independent risk factors for postoperative CAL, while intraoperative ALT independently reduced the postoperative CAL rate (OR 0.40, 95% CI 0.18-0.88, p = 0.022). 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.
机译：背景技术支持使用空气泄漏试验（ALT）的证据腹腔镜左侧结肠切除（LLCR）以测试旨在降低术后CA泄漏速度（CAL）的结肠直肠吻合术（CA）的完整性。本研究的目的是在选择LLCR后挑战ALT的使用。方法是对预期收集的数据库的回顾性分析，包括所有接受主要CA的患者的患者，1996年1月至2017年1月之间没有近端排便。执行ALT的决定是基于个人外科医生常规实践。进行多元分析以确定CAL的独立风险因素。结果在分析中，共有777LLCR没有近端转移的LLCR：在398名患者（ALT组）中测试CA，而术中ALT未在379名患者（无-Alt组）中进行。两组在人口统计学特征，指示和程序类型中类似。术中ALT在20（5％）患者中呈阳性：14例（70％）患者中创建的造口造口香，而6名（30％）患者单独进行缝合修复。总体而言，术后发生CAL在32名患者（4.1％）：术后CAL率为ALT患者（2.5％对5.8％，P = 0.025）下。在87.5％的病例中需要重新进食。在20名术中正面ALT患者中没有CAL发生。多变量分析表明，ASA得分3-4（或5.39,95％CI 2.53-11.51，P <0.001）和男性性别（或3.96,95％CI 1.66-9.43，P = 0.002）是术后钙的独立风险因素，虽然术中ALT独立地降低了术后CAL速率（或0.40,95％CI 0.18-0.88，P = 0.022）。结论术中ALT允许在术中可以有效管理的LLCR后检测AL缺陷，导致术后钙的风险显着下降。

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