[Anastomotic leakage in the gastrointestinal tract-repair and prognosis].
Anastomotic leakage is still a serious complication in surgery, resulting in increased morbidity and mortality. The reasons for its onset are various and due to two main reasons: general risk factors of the individual patient and technical surgical factors influencing the outcome after gastrointestinal anastomoses. Changes in the extracellular matrices, particularly due to collagen metabolism, and related disturbances are assumed to be important factors influencing wound healing processes. The technique chosen and the surgical skill are important with regard to inflammation and tissue necroses at the anastomotic line. Analysis of data obtained by clinical studies that concern clinical risk factors for anastomotic leakage reveal an inhomogeneous picture. Attempts to develop risk profiles or scores based on these results have failed until now. Problems encompass the complexity of wound healing processes, and it is questionable whether our current knowledge about them is complete. Therefore, profound understanding of anastomotic leakage requires in-depth analysis of the interaction of extracellular matrix components. Preliminary results indicate the presence of a risk population with collagen metabolism disturbances that have a major effect on wound healing after gastrointestinal anastomosis.
Stumpf
M
M
Chirurgische Klinik, Universitätsklinikum der RWTH Aachen. m.stumpf@chir.rwth-aachen.de
Klinge
U
U
Mertens
P R
PR
D000428:Alcohol Drinking / Q000009:adverse effects; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D002986:Clinical Trials as Topic; D003094:Collagen / Q000378:metabolism; D005109:Extracellular Matrix; D005260:Female; D041981:Gastrointestinal Tract / Q000601:surgery*; D006801:Humans; D008297:Male; D020782:Matrix Metalloproteinases / Q000378:metabolism; D009747:Nutritional Physiological Phenomena; D010538:Peritonitis / Q000150:complications; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D013528:Surgical Staplers; D014945:Wound Healing / Q000502:physiology
D003094:Collagen; D020782:Matrix Metalloproteinases