title: Colonic anastomoses and non-steroidal anti-inflammatory drugs.
abstract: Nonsteroidal anti-inflammatory drugs (NSAID) play an important role in the treatment of post-operative pain, particularly in the context of enhanced recovery after colorectal surgery. Several recent articles have suggested that NSAID may have a deleterious effect on colo-colic or colo-rectal anastomoses. The aim of this review is to analyze the evidence based on meta-analyses and cohort studies in the literature. A systematic review of clinical studies identified twelve studies including two meta-analyses and ten comparative cohort studies that included a large number of patients. The data in these studies are heterogeneous, often biased, and do not permit a formal recommendation based on a high level of evidence. The main conclusion of this review is that the balance of benefit vs. risk (analgesic effect/risk of anastomotic disruption) is acceptable; it appears (with a low level of evidence) that a prescription of NSAID for 48h after surgery may be recommended for elective colon surgery. Nevertheless, it is important to respect the specific contra-indications of NSAID and avoid post-operative NSAID use if there are risk factors for anastomotic leakage: advanced age, malnutrition, severe co-morbidities, intra-operative difficulties.
authors.affiliation: Service de chirurgie digestive, CHU Estaing, place Lucie-Aubrac, 63003 Clermont-Ferrand, France. Electronic address: kslim@chu-clermontferrand.fr.
authors.forename: K
authors.initials: K
authors.lastname: Slim
authors.affiliation: Département d'anesthésie, CHU de Liège, Liège, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Joris
authors.affiliation: UMR 991, CIC 1414, service anesthésie-réanimation 2, université Rennes 1, 35000 Rennes, France.
authors.forename: H
authors.initials: H
authors.lastname: Beloeil
mesh_terms: D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000139:chemically induced* / Q000209:etiology; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D003106:Colon / Q000601:surgery*; D006801:Humans; D010149:Postoperative Pain / Q000188:drug therapy*; D012007:Rectum / Q000601:surgery*; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: Anastomotic leak; Colonic anastomosis; Enhanced recovery; NSAID