title: Anastomotic leaks can be detected within 5 days following ileorectal anastomosis: a case-controlled study in patients with familial adenomatous polyposis.
abstract: OBJECTIVE
  To determine the earliest time point at which anastomotic leaks can be detected in patients undergoing total colectomy with primary ileorectal anastomosis for familial adenomatous polyposis.
  
  
  METHODS
  This was a case-controlled study of 10 anastomotic leak patients vs 20 controls following laparoscopic total colectomy with ileorectal anastomosis for familial adenomatous polyposis (from 96 consecutive patients between 2006 and 2013). Panel time-series data regression was performed using a double subscript structure to include both variables. A generalized least squares multivariate approach was applied in a random effects setting to calculate correlations for observations, with anastomotic leak being the dependent variable. Univariate and multivariate regression calculations were then performed according to individual observations at each recorded time point. Time-series analysis was used to determine when a variable became significant in the leak group.
  
  
  RESULTS
  Multivariate analysis identified a significant difference between leak and control groups in mean heart rate (P < 0.001), mean respiratory rate (P = 0.017) and mean urine output (P = 0.001). Time-point analysis showed that heart rate was significantly different between leak and control groups at postoperative day 4.25. Multivariate analysis identified a significant difference between groups in alanine transaminase (P = 0.006), bilirubin (P = 0.008), creatinine (P = 0.001), haemoglobin (P < 0.001) and urea (P = 0.007). There were no differences between groups with regard to markers of inflammation such as albumin, white blood cell count, neutrophil count and C-reactive protein.
  
  
  CONCLUSIONS
  Anastomotic leaks can be detected early (within 4.5 days of surgery) through changes in physiological, blood test and observational parameters, providing an opportunity for early intervention in these patients to salvage the anastomosis.
authors.affiliation: Department of Colorectal Surgery, St Mark's Hospital, Harrow, UK.|The Colorectal and Peritoneal Oncology Centre, Christie NHS Foundation Trust, Manchester, UK.
authors.forename: O
authors.initials: O
authors.lastname: Aziz
authors.affiliation: Department of Colorectal Surgery, St Mark's Hospital, Harrow, UK.
authors.forename: A
authors.initials: A
authors.lastname: Albeyati
authors.affiliation: Department of Colorectal Surgery, St Mark's Hospital, Harrow, UK.
authors.forename: M
authors.initials: M
authors.lastname: Derias
authors.affiliation: Department of Colorectal Surgery, St Mark's Hospital, Harrow, UK.
authors.forename: N
authors.initials: N
authors.lastname: Varsani
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London, UK.
authors.forename: H
authors.initials: H
authors.lastname: Ashrafian
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London, UK.
authors.forename: T
authors.initials: T
authors.lastname: Athanasiou
authors.affiliation: Department of Colorectal Surgery, St Mark's Hospital, Harrow, UK.|Department of Surgery and Cancer, Imperial College London, London, UK.
authors.forename: S K
authors.initials: SK
authors.lastname: Clark
authors.affiliation: Department of Colorectal Surgery, St Mark's Hospital, Harrow, UK.|Department of Surgery and Cancer, Imperial College London, London, UK.
authors.forename: J T
authors.initials: JT
authors.lastname: Jenkins
authors.affiliation: Department of Colorectal Surgery, St Mark's Hospital, Harrow, UK.|Department of Surgery and Cancer, Imperial College London, London, UK.
authors.forename: R H
authors.initials: RH
authors.lastname: Kennedy
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000175:diagnosis*; D016022:Case-Control Studies; D003082:Colectomy; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D010535:Laparoscopy; D016018:Least-Squares Analysis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012007:Rectum / Q000601:surgery; D012044:Regression Analysis; D013997:Time Factors; D055815:Young Adult
keywords: Anastomotic leak; familial adenomatous polyposis; ileorectal anastomosis; laparoscopic