Anne Karliczek

Drainage or nondrainage in elective colorectal anastomosis: a systematic review and meta‐analysis

Background  There is little agreement on prophylactic use of drains in anastomoses in elective colorectal surgery despite many randomized clinical trials. Once anastomotic leakage occurs it is generally agreed that drains should be used for therapeutic purposes. However, on prophylactic use no such agreement exists.

Results of streamlined regional ambulance transport and subsequent treatment of acute abdominal aortic aneurysms

Objective: To describe the triage of patients operated for non-ruptured and ruptured abdominal aortic aneurysms (AAAs) before the endovascular era. Design: Retrospective single-centre cohort study. Methods: All patients treated for an acute AAA between 1998 and 2001 and admitted to our hospital were evaluated in the emergency department for urgent AAA surgery. All time intervals, from the telephone call from the patient to the ambulance department, to the arrival of the patient in the operating theatre, were analysed. Intraoperative, hospital and 1-year survival were determined. Results: 160 patients with an acute AAA were transported to our hospital. Mean (SD) age was 71 (8) years, and 138 (86%) were men. 34 (21%) of these patients had symptomatic, non-ruptured AAA (sAAA) and 126 patients had ruptured AAA (rAAA). All patients with sAAA and 98% of patients with rAAA were operated upon. For the patients with rAAA, median time from telephone call to arrival at the hospital was 43 min (interquartile range 33–53 min) and median time from arrival at the hospital to arrival at the operating room was 25 min (interquartile range 11–50 min). Intraoperative mortality was 0% for sAAA and 11% for rAAA (p = 0.042), and hospital mortality was 12% and 33%, respectively (p = 0.014). Conclusions: A multidisciplinary unified strategy resulted in a rapid throughput of patients with acute AAA. Rapid transport, diagnosis and surgery resulted in favourable hospital mortality. Despite the fact that nearly all the patients were operated upon, survival was favourable compared with published data.

Intraoperative Assessment of Microperfusion with Visible Light Spectroscopy in Esophageal and Colorectal Anastomoses

Background: We evaluated the technical feasibility and stability of measurements using visible light spectroscopy to measure microvascular oxygen saturation (StO2) in gastrointestinal anastomoses. Methods: In consecutive esophageal (n = 14) or colorectal (n = 30) resections, during which an uncomplicated anastomosis was performed, measurements of serosal StO2 were performed during the procedure. Results: In esophageal resections, median (± standard error) StO2 was stable before and after anastomosis in the proximal esophagus (before: 66.0 ± 4.6, after: 68.3 ± 6.0%) and the gastric conduit (before: 70.6 ± 8.6, after: 69.8 ± 8.0%). Mean colorectal StO2 before and after anastomosis increased in the proximal part (71.3 ± 8.4 to 76.6 ± 8.2%; p < 0.005). Mean StO2 in the distal part remained stable (72.4 ± 6.6 to 74.8 ± 6.7%). Conclusions: Visible light spectroscopy is a feasible and fast method for intraoperative assessment of microperfusion of the serosa in esophageal and colorectal anastomosis. Future clinical studies will define its role in the prediction of anastomotic leakage.

Intraoperative Ischemia of the Distal End of Colon Anastomoses as Detected With Visible Light Spectroscopy Causes Reduction of Anastomotic Strength

BACKGROUND To explore new methods for intraoperative evaluation of tissue oxygenation, we evaluated the use of visible light spectroscopy as a predictor of anastomotic strength in an experimental model with ischemic murine colon anastomoses. MATERIALS AND METHODS Male rats (n = 34) were divided into 2 groups (ischemia and nonischemia). In the ischemia group the arteries of the distal colon were ligated until tissue oxygen saturation (StO2) dropped below 55%. A segment of the proximal part of the colon was resected until a well-perfused area was reached and an anastomosis was performed. In the nonischemia group, resection of a segment of descending colon and a colon anastomosis was performed. The animals were sacrificed on the 3rd or 7th postoperative d. The anastomosis was tested for bursting pressure and breaking strength. RESULTS After ligation of the relevant mesenteric arteries, StO2 of the distal part of the colon decreased (54.6% SD 6.4% versus 71.2% SD 7.4%, P <or= 0.05). On the 3rd or 7th postoperative d StO2 had normalized. Adhesion score in the ischemia group was higher compared to the nonischemia group (1.6 versus 0.4, P <or= 0.05). There were no differences in bursting pressure between both groups. Breaking strength was lower in the ischemia group on the 3rd postoperative d (162.3 SD 47.3 versus 212.6 SD 41.2, P <or= 0.05). CONCLUSION Ischemia can intraoperatively accurately be detected by visible light spectroscopy. Partially ischemic anastomoses showed more adhesions and diminished breaking strength in the early phase of healing, whereas bursting pressure was not affected. Low StO2 of a distal colon anastomosis appeared to be a risk factor for anastomotic dehiscence at d 3 and beyond.

Validity of Norwegian Rectal Cancer Registry data at a major university hospital 1997 - 2005

Background. The Norwegian Rectal Cancer Registry (NRCR) has been used extensively to monitor patient treatment and outcomes since its establishment in 1993. Control of data validity is crucial to ensure reliable information, but an audit of the NRCR data validity has not been performed so far. This study aims to validate NRCR data on patients diagnosed in the period 1997–2005, Department of Surgery, Haukeland University Hospital. Material and methods. The material comprises NRCR data on all 482 patients diagnosed with rectal cancer in the period 1997–2005 at a major Norwegian university hospital. We checked 50 variables for discrepancies by comparing NRCR data with the medical records. All erroneous registrations were recorded. Results. One hundred patients (21%) had one or more data discrepancies in the registry, and 131 errors (0.5%) were noted in total. Sixteen variables (32%) had no erroneous registrations. Pre-operative CT and type of surgical procedure had the highest proportion of erroneous registrations (2.1%). Recorded errors were grouped into five variable categories: Pre-operative evaluation and adjuvant treatment (40 errors), surgical treatment (44 errors), pathological evaluation (20 errors), complications (7 errors) and oncological outcomes (20 errors). The majority of erroneous registrations (45%) were considered minor in severity, 27% were moderate and 28% were major. Conclusion. Assessment of the NRCR data from a nine-year period showed a good data validity in this hospital cohort.