A standardized use of intraoperative anastomotic testing in colorectal surgery in the new millennium: is technology taking over? A systematic review and network meta-analysis.
Anastomotic leak
Colonoscopy
Indocyanine green
Postoperative complication
Journal
Techniques in coloproctology
ISSN: 1128-045X
Titre abrégé: Tech Coloproctol
Pays: Italy
ID NLM: 9613614
Informations de publication
Date de publication:
Jul 2019
Jul 2019
Historique:
received:
10
04
2019
accepted:
29
06
2019
pubmed:
16
7
2019
medline:
31
3
2020
entrez:
15
7
2019
Statut:
ppublish
Résumé
Anastomotic leakage (AL) remains the most challenging complication following colorectal resection. There are several tests that can be used to test anastomotic integrity intraoperatively including air leak testing (ALT) and intraoperative colonoscopy (IOC). Indocyanine green (ICG) can be used to visualise blood supply to the bowel used in the anastomosis. However, there is no consensus internationally regarding routine use and which technique is superior. The aim of this study was to determine which intraoperative anastomotoic leak test (IALT) was most effective in reducing AL. A systematic review and network meta-analysis were performed. An electronic systematic search was performed using Pubmed, CENTRAL, and Web of Science, of studies comparing ALT, IOC, and ICG. The inclusion criteria were as follows: (a) patients must have had colorectal surgery with formation of an anastomosis; (b) studies must have compared one or more IALTs; (c) and studies must have clear research methodology. Eleven articles totalling 3844 patients met the inclusion criteria and were included in this meta-analysis. Point estimation showed that the AL rate in the control group (no IALT) was significantly higher when compared to the ICG group (RR 0.44; Crl 0.14-0.87) and higher, but without reaching statistical significance, when compared to ALT (RR 0.53; Crl 0.21-1.30) and IOC (RR 0.49; Crl 0.10-1.80). Indirect comparison showed that the AL rate in the ICG group was lower, when compared to both ALT (RR 0.44; Crl 0.14-0.87) and IOC (RR 0.44; Crl 0.14-0.87). This study suggests that intraoperative testing for a good blood supply using ICG may reduce the AL rate following colorectal surgery.
Sections du résumé
BACKGROUND
BACKGROUND
Anastomotic leakage (AL) remains the most challenging complication following colorectal resection. There are several tests that can be used to test anastomotic integrity intraoperatively including air leak testing (ALT) and intraoperative colonoscopy (IOC). Indocyanine green (ICG) can be used to visualise blood supply to the bowel used in the anastomosis. However, there is no consensus internationally regarding routine use and which technique is superior. The aim of this study was to determine which intraoperative anastomotoic leak test (IALT) was most effective in reducing AL.
METHODS
METHODS
A systematic review and network meta-analysis were performed. An electronic systematic search was performed using Pubmed, CENTRAL, and Web of Science, of studies comparing ALT, IOC, and ICG. The inclusion criteria were as follows: (a) patients must have had colorectal surgery with formation of an anastomosis; (b) studies must have compared one or more IALTs; (c) and studies must have clear research methodology.
RESULTS
RESULTS
Eleven articles totalling 3844 patients met the inclusion criteria and were included in this meta-analysis. Point estimation showed that the AL rate in the control group (no IALT) was significantly higher when compared to the ICG group (RR 0.44; Crl 0.14-0.87) and higher, but without reaching statistical significance, when compared to ALT (RR 0.53; Crl 0.21-1.30) and IOC (RR 0.49; Crl 0.10-1.80). Indirect comparison showed that the AL rate in the ICG group was lower, when compared to both ALT (RR 0.44; Crl 0.14-0.87) and IOC (RR 0.44; Crl 0.14-0.87).
CONCLUSIONS
CONCLUSIONS
This study suggests that intraoperative testing for a good blood supply using ICG may reduce the AL rate following colorectal surgery.
Identifiants
pubmed: 31302816
doi: 10.1007/s10151-019-02034-6
pii: 10.1007/s10151-019-02034-6
doi:
Substances chimiques
Coloring Agents
0
Indocyanine Green
IX6J1063HV
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
625-631Références
JAMA. 2000 Apr 19;283(15):2008-12
pubmed: 10789670
BMJ. 2003 Sep 6;327(7414):557-60
pubmed: 12958120
Am J Epidemiol. 2007 Nov 15;166(10):1203-9
pubmed: 17712019
J Laparoendosc Adv Surg Tech A. 2008 Feb;18(1):27-31
pubmed: 18266570
Surg Endosc. 2009 Nov;23(11):2459-65
pubmed: 19301071
Arch Surg. 2009 May;144(5):407-11; discussion 411-2
pubmed: 19451481
BMJ. 2009 Jul 21;339:b2700
pubmed: 19622552
Surgery. 2010 Mar;147(3):339-51
pubmed: 20004450
Stat Med. 2010 Mar 30;29(7-8):932-44
pubmed: 20213715
Langenbecks Arch Surg. 2010 Nov;395(8):1025-30
pubmed: 20700603
Srp Arh Celok Lek. 2011 May-Jun;139(5-6):333-8
pubmed: 21858972
BMJ. 2011 Oct 18;343:d5928
pubmed: 22008217
Colorectal Dis. 2011 Nov;13 Suppl 7:12-7
pubmed: 22098511
Surg Laparosc Endosc Percutan Tech. 2012 Feb;22(1):65-7
pubmed: 22318063
Med Decis Making. 2013 Jul;33(5):607-17
pubmed: 23104435
Surg Endosc. 2013 Aug;27(8):3003-8
pubmed: 23404152
BMJ. 2013 May 14;346:f2914
pubmed: 23674332
PLoS One. 2014 Jul 03;9(7):e99682
pubmed: 24992266
Br J Surg. 2015 Apr;102(5):462-79
pubmed: 25703524
Dis Colon Rectum. 2015 Jun;58(6):582-7
pubmed: 25944430
Int J Med Robot. 2016 Dec;12(4):710-717
pubmed: 26486376
Surg Endosc. 2017 Apr;31(4):1836-1840
pubmed: 27553790
BMJ. 2016 Oct 12;355:i4919
pubmed: 27733354
Langenbecks Arch Surg. 2018 Feb;403(1):119-129
pubmed: 29209758
Tech Coloproctol. 2018 Jan;22(1):15-23
pubmed: 29230591
Br J Surg. 2018 Sep;105(10):1359-1367
pubmed: 29663330
Surg Endosc. 2019 May;33(5):1592-1599
pubmed: 30203203
Int J Colorectal Dis. 1986 Apr;1(2):96-8
pubmed: 3611941