Novosti
Khirurgii
This journal is
indexed in Scopus









Year 2022 Vol. 30 No 1

REVIEWS

DOI: https://dx.doi.org/10.18484/2305-0047.2022.1.86   |  

E.K. AGHAYEV, Z.E. ISMAYILOVA, T.E. MAMEDOV

PREVENTION OF SUTURE INSUFFICIENCY IN INTESTINAL ANASTOMOSES

Azerbaijan Medical University, Baku,
Republic of Azerbaijan

The failure of intestinal anastomotic suture is one of the urgent and dangerous problems in abdominal surgery. This problem not only complicates the course of the early postoperative period and increases financial costs, but it is also the main cause of deaths, the rate of which remains quite high with generalized peritonitis. The problem of the intestinal anastomotic leakage in the postoperative period forces researchers to develop various methods of preoperative preparation of patients, ways to strengthen the line of stitched ends of the intestine, new protocols for managing patients in the postoperative period. Despite the use of atraumatic and minimally invasive techniques as well as various stapling devices, and biopolymers of various compositions, the morbidity rate for an anastomotic leak remains quite high. The literature analysis demonstrates a tendency of preservation high rates of the suture failure of intestinal anastomosis. The actuality of this problem is especially clearly observed in case of emergency and urgent resection of the intestine against the background of acute intestinal obstruction, cancer intoxication and generalized peritonitis. The risk of anastomotic failure is believed to be caused by the age and general condition of a patient, the nature of the underlying disease, the presence of concomitant chronic diseases, the type of surgical operation, as well as the method and localization of the anastomosis being created. Despite the fact that there are a lot of sources devoted to the analysis of the causes of this problem, there is no consensus on the significance of risk factors and the effectiveness of the preventive methods used. In a number of publications there are contradictory data concerning the effectiveness of some preventive methods. Therefore, the solution of this problem requires new fundamental researches.

Keywords: intestinal anastomosis stitches failure, bowel resection, prevention of the anastomosis leakage, risk factors, reinforcement of anastomosis, biological impermeability of intestinal sutures, postoperative peritonitis
p. 86-94 of the original issue
References
  1. Phillips B. Reducing gastrointestinal anastomotic leak rates : review of challenges and solutions. Open Access Surg. 2016 Jan22;9:5-14. doi: 10.2147/OAS.S54936
  2. Turrentine FE, Denlinger CE, Simpson VB, Garwood RA, Guerlain S, Agrawal A, Friel CM, LaPar DJ, Stukenborg GJ, Jones RS. Morbidity, mortality, cost, and survival estimates of gastrointestinal anastomotic leaks. J Am Coll Surg. 2015 Feb;220(2):195-206. doi: 10.1016/j.jamcollsurg.2014.11.002
  3. Ataro G. Epidural block and neostigmine cause anastomosis leak. Open Acsess Surg. 2016 May 20;9:37-38. doi: 10.2147/OAS.S105594
  4. Chaouch MA, Kellil T, Jeddi C, Saidani A, Chebbi F, Zouari K. How to Prevent Anastomotic Leak in Colorectal Surgery? A Systematic Review. Ann Coloproctol. 2020 Aug;36(4):213-22. doi: 10.3393/ac.2020.05.14.2
  5. Subendran J, Siddiqui N, Victor JC, McLeod RS, Govindarajan A. NSAID use and anastomotic leaks following elective colorectal surgery: a matched case-control study. J Gastrointest Surg. 2014 Aug;18(8):1391-97. doi: 10.1007/s11605-014-2563-8
  6. Placer C, Enríquez-Navascués JM, Elorza G, Timoteo A, Mugica JA, Borda N, Saralegui Y, Elósegui JL. Preventing complications in colorectal anastomosis: results of a randomized controlled trial using bioabsorbable staple line reinforcement for circular stapler. Dis Colon Rectum. 2014 Oct;57(10):1195-201. doi: 10.1097/DCR.0000000000000207
  7. Park JS, Huh JW, Park YA, Cho YB, Yun SH, Kim HC, Lee WY. Risk factors of anastomotic leakage and long-term survival after colorectal surgery. Medicine (Baltimore). 2016 Feb;95(8):e2890. doi: 10.1097/MD.0000000000002890
  8. Bakker IS, Grossmann I, Henneman D, Havenga K, Wiggers T. Risk factors for anastomotic leakage and leak-related mortality after colonic cancer surgery in a nationwide audit. Br J Surg. 2014 Mar;101(4):424-32; discussion 432. doi: 10.1002/bjs.9395
  9. Parthasarathy M, Greensmith M, Bowers D, Groot-Wassink T. Risk factors for anastomotic leakage after colorectal resection: a retrospective analysis of 17 518 patients. Colorectal Dis. 2017 Mar;19(3):288-98. doi: 10.1111/codi.13476
  10. Lynch NP, Boyle E, Kavanagh EG. Selective vs Nonselective Nonsteroidal Anti-inflammatory Drugs and Anastomotic Leakage After Colorectal Surgery. JAMA Surg. 2015 Jul;150(7):685. doi: 10.1001/jamasurg.2015.0641
  11. Sammour T, Hill AG. Should colorectal surgeons continue to use nonsteroidal anti-inflammatory drugs? ANZ J Surg. 2017 Nov;87(11):861-62. doi: 10.1111/ans.13621
  12. Milne TGE, Jaung R, OGrady G, Bissett IP. Nonsteroidal anti-inflammatory drugs reduce the time to recovery of gut function after elective colorectal surgery: a systematic review and meta-analysis. Colorectal Dis. 2018 Aug;20(8):O190-O198. doi: 10.1111/codi.14268
  13. Kverneng Hultberg D, Angenete E, Lydrup ML, Rutegard J, Matthiessen P, Rutegard M. Nonsteroidal anti-inflammatory drugs and the risk of anastomotic leakage after anterior resection for rectal cancer. Eur J Surg Oncol. 2017 Oct;43(10):1908-14. doi: 10.1016/j.ejso.2017.06.010
  14. Rutegard M, Westermark S, Kverneng Hultberg D, Haapamäki M, Matthiessen P, Rutegard J. Non-steroidal anti-inflammatory drug use and risk of anastomotic leakage after anterior resection: a protocol-based study. Dig Surg. 2016;33(2):129-35. doi: 10.1159/000443216
  15. Slim K, Joris J, Beloeil H; Groupe Francophone de Réhabilitation Améliorée après Chirurgie (GRACE). Colonic anastomoses and non-steroidal anti-inflammatory drugs. J Visc Surg. 2016 Aug;153(4):269-75. doi: 10.1016/j.jviscsurg.2016.06.011
  16. Shogan BD, Belogortseva N, Luong PM, Zaborin A, Lax S, Bethel C, Ward M, Muldoon JP, Singer M, An G, Umanskiy K, Konda V, Shakhsheer B, Luo J, Klabbers R, Hancock LE, Gilbert J, Zaborina O, Alverdy JC. Collagen degradation and MMP9 activation by Enterococcus faecalis contribute to intestinal anastomotic leak. Sci Transl Med. 2015 May 6;7(286):286ra68. doi: 10.1126/scitranslmed.3010658
  17. Shakhsheer BA, Versten LA, Luo JN, Defazio JR, Klabbers R, Christley S, Zaborin A, Guyton KL, Krezalek M, Smith DP, Ajami NJ, Petrosino JF, Fleming ID, Belogortseva N, Zaborina O, Alverdy JC. Morphine promotes colonization of anastomotic tissues with collagenase - producing enterococcus faecalis and causes leak. J Gastrointest Surg. 2016 Oct;20(10):1744-51. doi: 10.1007/s11605-016-3237-5
  18. Wiegerinck M, Hyoju SK, Mao J, Zaborin A, Adriaansens C, Salzman E, Hyman NH, Zaborina O, van Goor H, Alverdy JC. Novel de novo synthesized phosphate carrier compound ABA-PEG20k-Pi20 suppresses collagenase production in Enterococcus faecalis and prevents colonic anastomotic leak in an experimental model. Br J Surg. 2018 Sep;105(10):1368-76. doi: 10.1002/bjs.10859
  19. Hyoju SK, Klabbers RE, Aaron M, Krezalek MA, Zaborin A, Wiegerinck M, Hyman NH, Zaborina O, Van Goor H, Alverdy JC. Oral Polyphosphate Suppresses Bacterial Collagenase Production and Prevents Anastomotic Leak Due to Serratia marcescens and Pseudomonas aeruginosa. Ann Surg. 2018 Jun;267(6):1112-18. doi: 10.1097/SLA.0000000000002167
  20. Zagirov UZ, Dalgatov GM, Zagirova NN. The defense by intravenous perftoran infusions of colic anastomosis in patients of old age. Vestn Novyh Med Tehnologij. 2008;V(4):95-97. http://www.medtsu.tula.ru/VNMT/Bulletin/2008/08B4.pdf (In Russ.)
  21. Shalaby M, Thabet W, Morshed M, Farid M, Sileri P. Shalaby M, Thabet W, Morshed M, Farid M, Sileri P. Preventive strategies for anastomotic leakage after colorectal resections: A review. World J Meta-Anal. 2019 Aug 31;7(8):389-98. doi: 10.13105/wjma.v7.i8.389
  22. Salmin RM, Prokopchik NI, Zhuk IG, Gayduk AV, Goretskaya MV, Pavlyukovets AYu, Zhmakin AI. Efficacy estimation of the colon anastomosis zone strengthening with the sponge TachoComb Novosti Kirurgii 2012;20(3):3-8. http://www.surgery.by/pdf/full_text/2012_3_1_ft.pdf ((In Russ.)
  23. Hamabe A, Ito M, Nishigori H, Nishizawa Y, Sasaki T. Preventive effect of diverting stoma on anastomotic leakage after laparoscopic low anterior resection with double stapling technique reconstruction applied based on risk stratification. Asian J Endosc Surg. 2018 Aug;11(3):220-26. doi: 10.1111/ases.12439
  24. Cortez AR, Kassam AF, Levinsky NC, Jung AD, Daly MC, Shah SA, Rafferty JF, Paquette IM. Enhanced recovery protocol improves postoperative outcomes and minimizes narcotic use following resection for colon and rectal cancer. Surg Open Sci. 2019 Jul 2;1(2):74-79. doi: 10.1016/j.sopen.2019.05.007. eCollection 2019 Oct.
  25. Nejdet B, Ayhan C, Doğan F, Mehmet A, Hüseyin E, Gülay D, Mustafa G, Nagehan B. An alternative to conventional hand-sewing colocolic anastomosis: anastomosis with absorbable surgical barrier film without sutures. Colorectal Dis. 2010 Dec;12(12):1260-67. doi: 10.1111/j.1463-1318.2009.02004.x
  26. Choy PY, Bissett IP, Docherty JG, Parry BR, Merrie A, Fitzgerald A. Stapled versus handsewn methods for ileocolic anastomoses. Cochrane Database Syst Rev. 2011 Sep 7;(9):CD004320. doi: 10.1002/14651858.CD004320.pub3
  27. Kim IY, Kim BR, Kim YW. Applying reinforcing sutures to stapled colorectal anastomosis after low anterior resection for rectal cancer. Eur J Surg Oncol. 2015 Jun;41(6):808-9. doi: 10.1016/j.ejso.2015.03.230
  28. Senagore A, Lane FR, Lee E, Wexner S, Dujovny N, Sklow B, Rider P, Bonello J; Bioabsorbable Staple Line Reinforcement Study Group. Bioabsorbable staple line reinforcement in restorative proctectomy and anterior resection: a randomized study. Dis Colon Rectum. 2014 Mar;57(3):324-30. doi: 10.1097/DCR.0000000000000065
  29. Slieker JC, Daams F, Mulder IM, Jeekel J, Lange JF. Systematic review of the technique of colorectal anastomosis. JAMA Surg. 2013 Feb;148(2):190-201. doi: 10.1001/2013.jamasurg.33
  30. Caziuc A, Calin Dindelegan G, Pall E, Mironiuc A. Stem cells improve the quality of colonic anastomoses A systematic review. J BUON. 2015 Nov-Dec;20(6):1624-29. https://jbuon.com/archive/20-6-1624.pdf
  31. Chereddy KK, Lopes A, Koussoroplis S, Payen V, Moia C, Zhu H, Sonveaux P, Carmeliet P, des Rieux A, Vandermeulen G, Préat V. Combined effects of PLGA and vascular endothelial growth factor promote the healing of non-diabetic and diabetic wounds. Nanomedicine. 2015 Nov;11(8):1975-84. doi: 10.1016/j.nano.2015.07.006
  32. Losi P, Briganti E, Errico C, Lisella A, Sanguinetti E, Chiellini F, Soldani G. Fibrin-based scaffold incorporating VEGF- and bFGF-loaded nanoparticles stimulates wound healing in diabetic mice. Acta Biomater. 2013 Aug;9(8):7814-21. doi: 10.1016/j.actbio.2013.04.019
  33. Li Z, Wang W, Wang X, Jiang L, Wang F, Liu Q. Sustained-released mixture of vascular endothelial growth factor 165 and fibrin glue strengthens healing of ileal anastomoses in a rabbit model with intraperitoneal infection. Ann Surg Treat Res. 2017 Sep;93(3):159-65. doi: 10.4174/astr.2017.93.3.159
  34. vant Sant HP, Kamman A, Hop WC, van der Heijden M, Lange JF, Contant CM. The influence of mechanical bowel preparation on long-term survival in patients surgically treated for colorectal cancer. Am J Surg. 2015 Jul;210(1):106-10. doi: 10.1016/j.amjsurg.2014.10.022
  35. Wirth U, Rogers S, Haubensak K, Schopf S, von Ahnen T, Schardey HM. Local antibiotic decontamination to prevent anastomotic leakage short-term outcome in rectal cancer surgery. Int J Colorectal Dis. 2018 Jan;33(1):53-60. doi: 10.1007/s00384-017-2933-2
  36. Scarborough JE, Mantyh CR, Sun Z, Migaly J. Combined mechanical and oral antibiotic bowel preparation reduces incisional surgical site infection and anastomotic leak rates after elective colorectal resection: an analysis of colectomy-targeted ACS NSQIP. Ann Surg. 2015 Aug;262(2):331-37. doi: 10.1097/SLA.0000000000001041
  37. Ohman KA, Wan L, Guthrie T, Johnston B, Leinicke JA, Glasgow SC, Hunt SR, Mutch MG, Wise PE, Silviera ML. Combination of Oral Antibiotics and Mechanical Bowel Preparation Reduces Surgical Site Infection in Colorectal Surgery. J Am Coll Surg. 2017 Oct;225(4):465-71. doi: 10.1016/j.jamcollsurg.2017.06.011
  38. Kiran RP, Murray AC, Chiuzan C, Estrada D, Forde K. Combined preoperative mechanical bowel preparation with oral antibiotics significantly reduces surgical site infection, anastomotic leak, and ileus after colorectal surgery. Ann Surg. 2015 Sep;262(3):416-25; discussion 423-5. doi: 10.1097/SLA.0000000000001416
  39. Schardey HM, Rogers SK, Schopf SK, von Ahnen T, Wirth U. Are gut bacteria associated with the development of anastomotic leaks? Coloproctology. 2017;39(2):94-100. doi: 10.1007/s00053-016-0136-x
  40. Althumairi AA, Canner JK, Pawlik TM, Schneider E, Nagarajan N, Safar B, Efron JE. Benefits of bowel preparation beyond surgical site infection: a retrospective study. Ann Surg. 2016 Dec;264(6):1051-57. doi: 10.1097/SLA.0000000000001576
  41. Moghadamyeghaneh Z, Hanna MH, Carmichael JC, Mills SD, Pigazzi A, Nguyen NT, Stamos MJ. Nationwide analysis of outcomes of bowel preparation in colon surgery. J Am Coll Surg. 2015 May;220(5):912-20. doi: 10.1016/j.jamcollsurg.2015.02.008
  42. Koskenvuo L, Lehtonen T, Koskensalo S, Rasilainen S, Klintrup K, Ehrlich A, Pinta T, Scheinin T, Sallinen V. Mechanical and oral antibiotic bowel preparation versus no bowel preparation in right and left colectomy: subgroup analysis of MOBILE trial. BJS Open. 2021 Mar 5;5(2):zrab011. doi: 10.1093/bjsopen/zrab011
  43. Liang Y, Xin W, Xi L, Fu H, Yang Y, Yang G, Li X. Role of mechanical and oral antibiotic bowel preparation in children with Hirschsprungs disease undergoing colostomy closure and pull-through. Transl Pediatr. 2021 Jan;10(1):153-59. doi: 10.21037/tp-20-306.
Address for correspondence:
AZ 1022, Republic of Azerbaijan
Baku, A. Kasumzade Str., 14,
Azerbaijan Medical University,
General Surgery Department,
tel.:+994 50 312 44 19,
e-mail: doc-elcin@yandex.ru,
Aghayev Elchin Kamil Ogly
Information about the authors:
Aghayev Elchin K., MD, Professor, Head of the General Surgery Department, Azerbaijan Medical University, Baku, Republic of Azerbaijan
https://orcid.org/0000-0003-0679-3008
Ismayilova Zulfiya E., PhD, Associate Professor of the General Surgery Department, Azerbaijan Medical University, Baku, Republic of Azerbaijan.
https://orcid.org/0000-0001-9462-9923
Mammadov Tapdig E., Senior Laboratory Assistant of the General Surgery Department, Azerbaijan Medical University, Baku, Republic of Azerbaijan.
https://orcid.org/0000-0001-6558-6821
Contacts | ©Vitebsk State Medical University, 2007