الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Anastomotic leaks occur in approximately 2% to 24% of patients undergoing colorectal surgery with higher rate in rectal anastomoses, and can lead to significant morbidity and mortality. AL could be detected anytime from 3 to 45 days postoperatively.
Aim of the study:
To evaluate the factors used for early detection of anastomotic leakage after hand-sewn colorectal anastomoses.
Setting of the study:
The present study was carried out in the department of Surgery of Menoufia university hospital after approval of the Ethics Committee had been obtained during a period started on April 2016 to November 2018.
The studied samples were selected according to the inclusion criteria:
Patients underwent colorectal anastomosis for different causes including (emergency& elective) with different risk factors, both sexes and all ages.
A written informed consent was obtained from all patients.
Sample Size:
Forty consecutive patients underwent colorectal anastomosis for different causes.
All patients were subjected Preoperative assessment in the form of:
(a) History taking: Personal &present history.
(b) Clinical examination: General &local.
(c)Investigations: Laboratory & radiological.
Operation: All patients were operated after performing the definitive therapeutic surgery which requires resection, hand-sewn intestinal anastomosis using Vicryl 2/0 was done in double layer interrupted anastomosis.
Postoperative follow up:
All patients were evaluated daily at the first 5days postoperative regarding:
- General: Fever, heart rate, blood pressure, respiratory rate, urine output, mental status, nutritional status.
- Local: signs of ileus (abdominal distention, vomiting, constipation), abdominal pain.
- Signs of infection (increased leukocytic count), kidney function
(increased urea & creatinine).
- Frank anastomotic leak, surgical site infection, wound dehiscence, burst abdomen.
- Daily c-RP postoperative for 5days.
- Microbiological study of peritoneal fluid (Aerobic& anaerobic cultures were done from the drain fluid on days 1, 3 & 5 postoperative).
Our study found that:
- The overall percentage of leakage in our study was 15%.
- Anastomotic leakage was diagnosed clinicaly on median day 6.
- -The incidence of AL was correlated with higher age.
- -Male gender is a risk factor for leakage.
- No statistical difference between elective &emergent anastomosis.
- Wound infection was significantly higher in anastomotic leakage group.
- Hospital stay was significantly longer in anastomotic leakage group.
- Escherichia coli, Enterococcus faecalis, Klebsiella, and bacteriod micro-organism were significantly more in AL group. E. coli was the most common micro-organism detected in patients with AL.
We found that Dutch leakage score has high sensitivity for early detection. Early detection determined which patient need more hospital stay and whom patient is ready for discharge. Application of DULK score helped us to diagnose AL three days earlier.
Mortality and morbidity following AL were markedly decreased. The principle of this score is not to force surgical intervention but to alert the care-takers of the risk of anastomotic leak and then to intensify surveillance and prescription of the necessary complementary investigations leading to early diagnosis. Thus DULK score has a major role in risk management and ‗‗failure to rescue‘‘ reduction
Last we can say that DULK score can be applied for all cases of intestinal anastomosis helping us to decrease mortality and morbidity following large intestinal anastomosis.
An early and persistent elevation of CRP after colorectal surgery with anastomosis is a marker of anastomotic leakage in patients in whom other infectious complications (respiratory, urinary tract and surgical wound infections) could be excluded.
So patients with CRP values <120 mg/l on the third postoperative day can be safely discharged from hospital.