title: Improved diagnosis and treatment of anastomotic leakage after colorectal surgery.
abstract: OBJECTIVE
  This study aimed at testing feasibility of a standardised postoperative surveillance protocol to reduce delay in the diagnosis of anastomotic leakage (AL) and, subsequently, mortality.
  
  
  METHODS
  Patient files of patients operated between 1996 and 1999 were reviewed and used as historical controls (n=1066). As a result, a protocol for standardised post-operative surveillance was designed using easily accessible, clinical parameters. Between August 2004 and August 2006, all operated patients with a colorectal anastomosis (n=223) were prospectively subjected to this standardised surveillance.
  
  
  RESULTS
  AL was diagnosed in 7.0% of patients in the historical control group and 9.4% of patients in the standardised surveillance group. AL mortality decreased from 39% to 24% with standardised surveillance (n.s.). The delay in AL diagnosis was significantly reduced during standardised surveillance (4 versus 1.5 days, p=0.01), which was confirmed in the multivariate analysis.
  
  
  CONCLUSIONS
  With non-standardised postoperative monitoring, AL was associated with a high mortality rate. Patients were subjected to several additional tests, which were not primarily useful to diagnose AL. Standardised postoperative surveillance for AL was introduced successfully and resulted in a shorter delay between the first signs and symptoms to the confirmation of AL.
authors.affiliation: Department of Surgery, Haga Hospital, The Hague, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: den Dulk
authors.forename: S L
authors.initials: SL
authors.lastname: Noter
authors.forename: E R
authors.initials: ER
authors.lastname: Hendriks
authors.forename: M A M
authors.initials: MA
authors.lastname: Brouwers
authors.forename: C H
authors.initials: CH
authors.lastname: van der Vlies
authors.forename: R J
authors.initials: RJ
authors.lastname: Oostenbroek
authors.forename: A G
authors.initials: AG
authors.lastname: Menon
authors.forename: W H
authors.initials: WH
authors.lastname: Steup
authors.forename: C J H
authors.initials: CJ
authors.lastname: van de Velde
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D003107:Colorectal Surgery / Q000009:adverse effects*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate