Objective: To determine the value of anastomotic leaktesting of left-sided colorectal anastomoses.
Design: Cohort analysis.
Setting: Subspecialty practice at a tertiary care facility.
Patients: Consecutive subjects were selected from a
prospective colorectal database of 2627 patients
treated between January l, 2001, and December 31,
2007.
Intervention: Creation of left-sided colorectal anastomoses
and air leak testing per surgeon preference.
Main Outcomes Measures: Anastomosis type, method
(handsewn vs stapled), performance of air leak testing,
repair method of anastomoses after air leak tests yielding
positive results, and development of postoperative
clinical leak.
Results: A total of 998 left-sided colorectal anastomoses
were performed without proximal diversion; 90.1% were
stapled and 9.9% were handsewn. Intraoperative air leaks
were noted in 65 of 825 tested anastomoses (7.9%), that is,
7.8% of stapled anastomoses and 9.5% of handsewn anastomoses.
Aclinicalleakdevelopedin48patients(4.8%).Clinical
leaks were noted in 7.7% of anastomoses with positive
air leak test resultscomparedwith3.8%ofanastomoseswith
negative air leak test results and 8.1% of all untested anastomoses
(P.03). If air leak testing yielded positive results,
suture repair alone was associated with the highest rate of
postoperative clinical leak compared with diversion or reanastomosis,
12.2% vs 0% vs 0%, respectively (P=.19).
Conclusions: Our data indicate a high rate of air leaks
at air leak testing of left-sided colorectal anastomoses. In
addition, the high rate of clinical leaks in untested anastomoses
leads us to recommend air leak testing of all leftsided
anastomoses, whether stapled or handsewn.
Arch Surg. 2009;144(5):407-411
Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of RadiologyIn the United States, colorectal cancer (CRC) is the third most common cancer diagnosed among men and women and the second leading cause of death from cancer. CRC largely can be prevented by the detection and removal of adenomatous polyps, and survival is significantly better when CRC is diagnosed while still localized. In 2006 to 2007, the American Cancer Society, the US Multi Society Task Force on Colorectal Cancer, and the American College of Radiology came together to develop consensus guidelines for the detection of adenomatous polyps and CRC in asymptomatic average-risk adults. In this update of each organization's guidelines, screening tests are grouped into those that primarily detect cancer early and those that can detect cancer early and also can detect adenomatous polyps, thus providing a greater potential for prevention through polypectomy. When possible, clinicians should make patients aware of the full range of screening options, but at a minimum they should be prepared to offer patients a choice between a screening test that is effective at both early cancer detection and cancer prevention through the detection and removal of polyps and a screening test that primarily is effective at early cancer detection. It is the strong opinion of these 3 organizations that colon cancer prevention should be the primary goal of screening........http://www.4shared.com/dir/6115382/9abe40e3/COLON_RECTO_Y_ANO.html
