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Research article
Tsuyoshi Enomoto
Corresponding Author
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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.
Keywords
diverting stoma; loop ileostomy; anastomotic leakage; rectal resection; early closure
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CURRENT STATUS: Published
View the published article at BMC Surgery.
Version 3
Posted 26 Feb, 2020
No community comments so far
Submission checks complete
On 26 Feb, 2020
Editorial decision: Accept
On 26 Feb, 2020
No comments provided
Editorial decision: Minor revision
On 24 Feb, 2020
Review #2 received
Received 15 Feb, 2020
Review #1 received
Received 07 Feb, 2020
Reviewers invited
Invitations sent on 05 Feb, 2020
Reviewer #1 agreed
On 05 Feb, 2020
Reviewer #2 agreed
On 05 Feb, 2020
Editor assigned
On 04 Feb, 2020
Submission checks complete
On 03 Feb, 2020
Editor invited
On 03 Feb, 2020
No comments provided
Review #3 received
Received 28 Jan, 2020
Editorial decision: Minor revision
On 28 Jan, 2020
Review #1 received
Received 20 Jan, 2020
Reviewer #3 agreed
On 12 Jan, 2020
Reviewer #2 agreed
On 16 Dec, 2019
Review #2 received
Received 16 Dec, 2019
Editor assigned
On 15 Dec, 2019
Reviewers invited
Invitations sent on 15 Dec, 2019
Reviewer #1 agreed
On 15 Dec, 2019
Submission checks complete
On 11 Dec, 2019
Editor invited
On 10 Dec, 2019
First submitted
On 29 Nov, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at BMC Surgery.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Tsuyoshi Enomoto
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Surgery.
Version 3
Posted 26 Feb, 2020
No community comments so far
Submission checks complete
On 26 Feb, 2020
Editorial decision: Accept
On 26 Feb, 2020
No comments provided
Editorial decision: Minor revision
On 24 Feb, 2020
Review #2 received
Received 15 Feb, 2020
Review #1 received
Received 07 Feb, 2020
Reviewers invited
Invitations sent on 05 Feb, 2020
Reviewer #1 agreed
On 05 Feb, 2020
Reviewer #2 agreed
On 05 Feb, 2020
Editor assigned
On 04 Feb, 2020
Submission checks complete
On 03 Feb, 2020
Editor invited
On 03 Feb, 2020
No comments provided
Review #3 received
Received 28 Jan, 2020
Editorial decision: Minor revision
On 28 Jan, 2020
Review #1 received
Received 20 Jan, 2020
Reviewer #3 agreed
On 12 Jan, 2020
Reviewer #2 agreed
On 16 Dec, 2019
Review #2 received
Received 16 Dec, 2019
Editor assigned
On 15 Dec, 2019
Reviewers invited
Invitations sent on 15 Dec, 2019
Reviewer #1 agreed
On 15 Dec, 2019
Submission checks complete
On 11 Dec, 2019
Editor invited
On 10 Dec, 2019
First submitted
On 29 Nov, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Surgery.
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.
Figure 1
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