Early Detection of anastomotic leakage following elective colectomy

Abstract

Anastomotic leakage is the most feared complication following colonic surgery. Despite recent improvements in perioperative care and operative technique, anastomotic leakage remains a major clinical complication with a significant mortality rate and significant short and long-term morbidity. Chapter 1 introduces this topic with a discussion on colonic anastomosis, the pathophysiology of healing, and the role of inflammatory biomarkers in this process. The theory of inflammatory imbalance following colorectal surgery is introduced and outlines the aim of this thesis – to define a biomarker profile for early detection of anastomotic leakage. A review of the normal inflammatory response in the clinical context specific to colonic surgery is explored in Chapter Two. Chapter Three then explores the difficulty surrounding the early diagnosis of anastomotic leakage, followed by a literature review in Chapter Four which discusses the utility of inflammatory biomarkers in the early detection of anastomotic leakage. Findings from Chapters Two, Three and Four are incorporated in the development of the biomarkers and anastomotic leakage longitudinal (BALL) study. This is a prospective study with the methodology outlined in Chapter Five, and results presented in Chapter Six and Chapter Seven. This prospective study shows that inflammatory biomarkers are useful in the diagnosis of anastomotic leakage. The individual findings from each chapter are then discussed in a unified manner in Chapter 8, followed by a conclusion in Chapter 9.