­
medigraphic.com
ISSN 2594-1518 (Electronic)
ISSN 1405-0099 (Print)

2013, Number 1

<< Back Next >>

Cir Gen 2013; 35 (1)

The nutritional state does not influence development of anastomotic dehiscence in a Mexican population

Silva GJC, Vásquez CS, Jarquín AA, Vela MP

Language: Spanish
References: 40
Page: 9-15
PDF size: 202.64 Kb.


ABSTRACT

Objective: To describe the risk factors associated to the development of an anastomotic dehiscence in patients subjected to intestinal surgery in a Mexican population, emphasizing the nutritional state of the patient.
Setting: Surgery Service, Regional High Specialty Hospital of Oaxaca, Mexico. Ministry of Health (Third Level Health Care Center).
Design: Clinical, ambispective, ambilective study of cases and controls.
Statistical analysis: Univariate analysis with χ2, simple binomial logistic regression, and multivariate logistic regression.
Patients and methods: We analyzed 144 patients subjected to 214 resections and/or intestinal shunts with anastomoses. We considered different clinical, demographic, and laboratory factors associated to dehiscence of anastomoses. The main risk factors considered were: number of anastomoses, type of anastomoses, IMC, antecedents of cancer, creatinine, smoking, type of surgery, hemoglobin level, leukocytes and lymphocyte counts, clotting time, blood biometrics, gender, intraoperative hypotension, diabetes mellitus, cardiovascular disease, ASA score, hyperbilirubinemia, BUN, surgical bleeding. We assessed the association of these variables with anastomotic dehiscence and mortality in the studied population.
Results: We analyzed 144 patients subjected to 214 anastomoses. The univariate analysis revealed that the variables with statistical significance for deh cence were age (p ‹ 0.001), bleeding (p = 0.01), and need of transfusions (p = 0.03). The presence of hypoalbuminemia or a BMI ‹ 15 was not significant in either the univariate and multivariate analyses. Surgical bleeding and the need of transfusions were the most significant predictors for the development of anastomotic dehiscence in the multivariate analysis (p ‹ 0.01).
Conclusions: The presence of hypoalbuminemia and a low BMI does not increase the risk of anastomotic dehiscence in the studied population. The main risk factors associated to anastomotic leakage are transoperative bleeding and administration of hemoderivates during the perioperative time.


REFERENCES

  1. Goulder F. Bowel anastomoses: The theory, the practice and the evidence base. World J Gastrointest Surg. 2012; 4: 208-213.

  2. Eberl T, Jagoditsch M, Klingler A, Tschmelitsch J. Risk factors for anastomotic leakage after resection for rectal cancer. Am J Surg. 2008; 196: 592-598.

  3. Matthiessen P, Hallböök O, Rutegárd J, Simert G, Sjödahl R. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg. 2007; 246: 207-214.

  4. Hyman NH. Managing anastomotic leaks from intestinal anastomoses. Surgeon. 2009; 7: 31-35.

  5. Golub R, Golub RW, Cantu R Jr, Stein HD. A multivariate analysis of factors contributing to leakage of intestinal anastomoses. J Am Coll Surg. 1997; 184: 364-372.

  6. Davis B, Rivadeneira DE. Complications of colorectal anastomoses: leaks, strictures, and bleeding. Surg Clin North Am. 2013; 93: 61-87.

  7. Sánchez-Fernández P, Mier DJ, Castillo-González A, Blanco-Benavides R, Zárate-Castillo J. Factores de riesgo para dehiscencia de herida quirúrgica. Cir Cir. 2000; 68: 198-203.

  8. Domínguez-Jimenez GL, Athié-Athié A, Mijares-García JM, Cárdenas-Lailson E, Perez-Reyez E. Efecto de la desnutrición en la anastomosis colónica de la rata. Cir Cir. 2001; 23: 81-86.

  9. Hyman NH, Osler T, Cataldo P, Burns EH, Shackford SR. Anastomotic leaks after bowel resection: what does peer review teach us about the relationship to postoperative mortality? J Am Coll Surg. 2009; 208: 48-52.

  10. Burden S, Todd C, Hill J, Lal S. Pre-operative nutrition support in patients undergoing gastrointestinal surgery. Cochrane Database Syst Rev. 2012; 11: CD008879.

  11. Naskar TK, Chakraborty S, Mukhopadhyay S, Agnes C, Majumdar P. Did you choose the right suture material for skin closure in elective caesarean section? J Indian Med Assoc. 2012; 110: 644-648.

  12. Food and Agriculture Organization of the United Nations. The double burden of malnutrition. Case studies from six developing countries. FAO Food Nutr Pap. 2006; 84: 1-334.

  13. Docherty JG, McGregor JR, Akyol AM, Murray GD, Galloway DJ. Comparison of manually constructed and stapled anastomoses in colorectal surgery. West of Scotland and Highland Anastomosis Study Group. Ann Surg. 1995; 221: 176-184.

  14. Fingerhut A, Elhadad A, Hay JM, Lacaine F, Flamant Y. Infraperitoneal colorectal anastomosis: hand-sewn versus circular staples. A controlled clinical trial. French Associations for Surgical Research. Surgery. 1994; 116: 484-490.

  15. Hyman N, Manchester TL, Osler T, Burns B, Cataldo PA. Anastomotic leaks after intestinal anastomosis: it’s later than you think. Ann Surg. 2007; 245: 254-258.

  16. Kingham TP, Pachter HL. Colonic anastomotic leak: risk factors, diagnosis, and treatment. J Am Coll Surg. 2009; 208: 269-278.

  17. Morales MP, Miedema BW, Scott JS, de la Torre RA. Management of postsurgical leaks in the bariatric patient. Gastrointest Endosc Clin N Am. 2011; 21: 295-304.

  18. Morks AN, Ploeg RJ, Sijbrand Hofker H, Wiggers T, Havenga K. Late anastomotic leakage in colorectal surgery: a significant problem. Colorectal Dis. 2013; 15: e271-275.

  19. Brisinda G, Vanella S, Cadeddu F, Mazzeo P. Colonic anastomotic leak: risk factors, diagnosis, and treatment. J Am Coll Surg. 2009; 208: 1152-1154.

  20. Kang CY, Halabi WJ, Chaudhry OO, Nguyen V, Pigazzi A, Carmichael JC, et al. Risk factors for anastomotic leakage after anterior resection for rectal cancer. JAMA Surg. 2013; 148: 65-71.

  21. Schrock TR, Deveney CW, Dunphy JE. Factor contributing to leakage of colonic anastomoses. Ann Surg. 1973; 177: 513-518.

  22. Iancu C, Mocan LC, Todea-Iancu D, Mocan T, Acalovschi I, Ionescu D, et al. Host-related predictive factors for anastomotic leakage following large bowel resections for colorectal cancer. J Gastrointestin Liver Dis. 2008; 17: 299-303.

  23. Karanjia ND, Corder AP, Bearn P, Heald RJ. Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum. Br J Surg. 1994; 81: 1224-1226.

  24. Mullen JL, Gertner MH, Buzby GP, Goodhart GL, Rosato EF. Implications of malnutrition in the surgical patient. Arch Surg. 1979; 114: 121-125.

  25. Law NW, Ellis H. The effect of parenteral nutrition on the healing of abdominal wall wounds and colonic anastomoses in protein-malnourished rats. Surgery. 1990; 107: 449-454.

  26. Ward MW, Danzi M, Lewin MR, Rennie MJ, Clark CG. The effects of subclinical malnutrition and refeeding on the healing of experimental colonic anastomoses. Br J Surg. 1982; 69: 308-310.

  27. Delany HM, Demetriou AA, Teh E, Levenson SM. Effect of early postoperative nutritional support on skin wound and colon anastomosis healing. JPEN J Parenter Enteral Nutr. 1990; 14: 357-361.

  28. Martinez-Mas E, Vazquez-Prado A, Larrocha-Grau M, Artigues-Sanchez E, Lloris-Carsi JM, Trullenque-Peris R. The impact of low-residue enteral feeding on the healing of colonic anastomoses. Hepatogastroenterology. 1993; 40: 481-484.

  29. Demetriades H, Botsios D, Kazantzidou D, Sakkas L, Tsalis K, Manos K, et al. Effect of early postoperative enteral feeding on the healing of colonic anastomoses in rats. Comparison of three different enteral diets. Eur Surg Res. 1999; 31: 57-63.

  30. Wheble GA, Knight WR, Khan OA. Enteral versus total parenteral nutrition following major upper gastrointestinal surgery. Int J Surg. 2012; 10: 194-197.

  31. Pacelli F, Bossola M, Papa V, Malerba M, Modesti C, Sgadari A, et al. Enteral versus parenteral nutrition after major abdominal surgery: an even match. Arch Surg. 2001; 136: 933-936.

  32. Braga M, Gianotti L, Vignali A, Cestari A, Bisagni P, Di Carlo V. Artificial nutrition after major abdominal surgery: impact of route of administration and composition of the diet. Crit Care Med. 1998; 26: 24-30.

  33. de Aguilar-Nascimento JE, Bicudo-Salomao A, Portari-Filho PE. Optimal timing for the initiation of enteral and parenteral nutrition in critical medical and surgical conditions. Nutrition. 2012; 28: 840-843.

  34. Wobbes T, Joosen KH, Kuypers HH, Beerthuizen GI, Theeuwes GM. The effect of packed cells and whole blood transfusions on survival after curative resection for colorectal carcinoma. Dis Colon Rectum. 1989; 32: 743-748.

  35. Wobbes T, Bemelmans BL, Kuypers JH, Beerthuizen GI, Theeuwes AG. Risk of postoperative septic complications after abdominal surgical treatment in relation to perioperative blood transfusion. Surg Gynecol Obstet. 1990; 171: 59-62.

  36. Tadros T, Wobbes T, Hendriks T. Blood transfusion impairs the healing of experimental intestinal anastomoses. Ann Surg. 1992; 215: 276-281.

  37. Waymack JP, Balakrishnan K, McNeal N, Gonce S, Miskell P, Warden GD, et al. Effect of blood transfusions on macrophage-lymphocyte interaction in an animal model. Ann Surg. 1986; 204: 681-685.

  38. Waymack JP, Robb E, Alexander JW. Effect of transfusion on immune function in a traumatized animal model. II. Effect on mortality rate following septic challenge. Arch Surg. 1987; 122: 935-939.

  39. Waymack JP, Rapien J, Garnett D, Tweddell JS, Alexander JW. Effect of transfusion on immune function in a traumatized animal model. Arch Surg. 1986; 121: 50-55.

  40. Morgenstern L, Yamakawa T, Ben-Shoshan M, Lippman H. Anastomotic leakage after low colonic anastomosis. Clinical and experimental aspects. Am J Surg. 1972; 123: 104-109.




2020     |     www.medigraphic.com

    Este sitio utiliza cookies   Estoy de acuerdo