title: Outcomes of asymptomatic anastomotic leaks found on routine postoperative water-soluble enema following anterior resection for cancer.
abstract: BACKGROUND
  The incidence and consequence of an anastomotic leak associated with low anterior resection for cancer mandates covering stoma in most cases. A water-soluble enema is often performed to assess anastomotic integrity prior to stoma reversal. The functional outcome following reversal in patients with occult radiologically detected leaks is poorly defined. The goal of the present study was to determine the functional outcome in patients with a radiologically detected anastomotic leak who subsequently underwent stoma reversal.
  
  
  METHODS
  This case control study used patients with and without radiologically detected occult anastomotic leak having undergone reversal of covering stomata. The study group was matched with controls for age, gender, procedure, tumor stage, and adjuvant/neoadjuvant therapy. Validated fecal incontinence quality of life (FIQL), Cleveland Clinic Fecal Incontinence Score (CCFIS), and the Memorial Sloan-Kettering Cancer Center (MSKCC) Bowel Function Index (BFI) were used. Patient satisfaction, medication use, and ancillary procedures prior to closure were also recorded.
  
  
  RESULTS
  Thirteen patients with radiologically detected occult anastomotic leaks and 13 matched controls were identified from a prospectively maintained database. The FIQL, CCFIS, and MSKCC BFI scores were significantly reduced in those with occult leaks. The mean number of radiological and surgical interventions was significantly greater in the patients with occult leaks. Antidiarrheal and bulking agent use, as well as patient satisfaction, were the same for both groups. Only one patient in the occult leak group would not undergo stoma reversal again.
  
  
  CONCLUSIONS
  Reversal of a defunctioning ileostomy in the presence of an occult radiological leak can be associated with poorer functional outcomes, but patient satisfaction is undiminished.
authors: Academic Surgical Unit, Castle Hill Hospital, University of Hull, Cottingham, HU16 5JQ, UK, sdfkilleen@eircom.net.
authors: S
authors: S
authors: Killeen
authors: P
authors: P
authors: Souroullas
authors: H
authors: H
authors: Ho Tin
authors: I A
authors: IA
authors: Hunter
authors: H
authors: H
authors: O'Grady
authors: J
authors: J
authors: Gunn
authors: J E
authors: JE
authors: Hartley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000000981:diagnostic imaging* / Q000453:epidemiology; D016022:Case-Control Studies; D013505:Digestive System Surgical Procedures; D004733:Enema; D005242:Fecal Incontinence; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011788:Quality of Life; D011859:Radiography; D012004:Rectal Neoplasms / Q000601:surgery*; D012086:Reoperation; D016896:Treatment Outcome
references: Dis Colon Rectum. 2013 Mar;56(3):275-80
references: 23392139
references: Int J Colorectal Dis. 2007 Aug;22(8):903-10
references: 17294197
references: World J Surg. 2008 Jun;32(6):1124-9
references: 18259805
references: Surg Laparosc Endosc Percutan Tech. 2013 Apr;23(2):e74-7
references: 23579534
references: Br J Surg. 2001 Mar;88(3):400-4
references: 11260107
references: Surg Endosc. 2009 Jun;23(6):1379-83
references: 19037698
references: Br J Surg. 1996 Jan;83(1):60-2
references: 8653367
references: Lancet. 2011 Mar 19;377(9770):997-1003
references: 21420555
references: Colorectal Dis. 2010 Jul;12(7 Online):e76-81
references: 19438879
references: Colorectal Dis. 2010 Jul;12(7 Online):e104-8
references: 19508536
references: Dis Colon Rectum. 2005 Apr;48(4):735-43
references: 15785900
references: Colorectal Dis. 2010 Jul;12(7 Online):e82-7
references: 19594606
references: Dis Colon Rectum. 2005 Jul;48(7):1353-65
references: 15868235
references: Colorectal Dis. 2011 Jan;13(1):26-9
references: 20649900
references: Colorectal Dis. 2011 Mar;13(3):272-83
references: 19912285
references: J Gastrointest Surg. 2010 Jul;14(7):1190-6
references: 20094811
references: Dis Colon Rectum. 2007 Jul;50(7):1040-6
references: 17525861
references: Langenbecks Arch Surg. 2003 Feb;387(11-12):406-10
references: 12607120
references: Colorectal Dis. 2008 Jul;10(6):587-92
references: 18070185
references: JAMA Surg. 2013 Jan;148(1):65-71
references: 22986932
references: Dis Colon Rectum. 2011 Jun;54(6):747-52
references: 21552061