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Relation between postoperative ileus and anastomotic leakage after colorectal resection: a post hoc analysis of a prospective randomized controlled trial
Author(s) -
Peters E. G.,
Dekkers M.,
LeeuwenHilbers F. W.,
Daams F.,
Hulsewé K. W. E.,
Jonge W. J.,
Buurman W. A.,
Luyer M. D. P.
Publication year - 2017
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.13582
Subject(s) - medicine , interquartile range , prospective cohort study , colorectal surgery , gastroenterology , ileus , randomized controlled trial , surgery , post hoc analysis , anastomosis , abdominal surgery
Abstract Aim Anastomotic leakage ( AL ) following abdominal surgery is a critical determinant of postoperative recovery, of which the aetiology is largely unknown. Interestingly, interventions aimed at reducing the inflammatory response and postoperative ileus ( POI ) have an unexpected effect on AL . The aim of this study was to investigate the relation of POI with inflammation and AL after colorectal resection. Method A post hoc analysis of a prospective randomized controlled trial in which patients underwent a colorectal resection was performed. Patients undergoing a colorectal resection were stratified into having or not having POI . The incidence of AL and other clinical parameters was registered prospectively. Intestinal fatty acid binding protein (I‐ FABP , a marker for tissue damage) and the inflammatory response in plasma and colon tissue were determined. Results AL was present in nine of 43 patients in the POI group, and in one of 65 in the group without POI ( P < 0.001). There was a significant association between POI and AL ( OR 12.57, 95% CI : 2.73–120.65; P = 0.0005). Patients with POI had significantly higher plasma levels of soluble tumour necrosis factor receptor 1 ( TNFRSF 1A) at 4 h postoperatively (0.89 ng/l, interquartile range 0.56) than patients without POI (0.80 ng/l, interquartile range 0.37; P = 0.04) and higher plasma levels of C‐reactive protein on the second day postoperatively (234 ± 77 vs 163 ± 86 mg/l; P = 0.001). Patients who developed AL had significantly higher plasma levels of I‐ FABP compared with patients without AL at 24 h after onset of surgery. Conclusion POI is associated with a higher prevalence of AL and an increased inflammatory response.