Crafa F, Striano A, Esposito F, Rossetti ARR, Baiamonte M, Gianfreda V, Longo A. The "Reverse Air-Leak Test" : A New Technique for the Assessment of Low Colorectal Anastomosis.
Ann Coloproctol 2020:ac.2020.09.21.1. [PMID:
33332954 PMCID:
PMC8898631 DOI:
10.3393/ac.2020.09.21.1]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/21/2020] [Indexed: 12/14/2022] Open
Abstract
Background
Anastomotic leakage is a fearsome complication in rectal surgery. Surgeons perform the classic air-leak test, although its real effectiveness is still debated. The aim of this study was to describe a personal technique of reverse air leak test in which low colorectal anastomosis were assessed transanally through the intra-rectal irrigation of a few mL of saline solution.
Methods
From October 2014 to November 2019 eleven patients with low rectal cancer (Type 1 in Roullier classification) were included in this study. At the beginning of the procedure, a circular anal dilator (CAD) was inserted into the anus. A side-to-end colorectal anastomosis was performed. A few mL of saline solution were injected into the rectum and the entire anastomotic line was directly explored. The appearance of bubbles was considered as an anastomotic defect and repaired with an interrupted suture. A fluorescence angiography after intravenous injection of Indocyanine green was performed in order to evaluate the perfusion of the anastomosis.
Results
In 4 cases (36.3%) the reverse air-leak test was positive. The defect was repaired and a confirmation test was performed. In all patients, near-infrared evaluation showed not perfusion defect (grade 0) in low colorectal anastomosis. No post-operative fistula was detected in cohort study. A protective stoma was performed in 10 patients. At 90-days there were no complications and stoma closure was performed as planned.
Conclusion
The reverse air-leak test is a simple, feasible and effective procedure to identify anastomotic leak in low colorectal anastomoses.
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