EARLY DETECTION OF ANASTOMOTIC LEAKS AFTER COLORECTAL SURGERY BY MEASURING ENDOTOXIN IN THE DRAINAGE FLUID

Background/Aims: Early detection of anastomotic leaks after colorectal anastomosis is essential for adequate intervention to prevent periton itis. We investigated whether the measurement of endotoxin (LPS) conce ntrations in the drainage has any value for the early detection of ana stomotic leaks. Materials and Methods: Twenty two patients with colore ctal anastomosis were enrolled in this study, 3 developed clinically e stablished signs of anastomotic leaks and 19 recovered without complic ations. LPS concentrations in the drainage, the total daily excreted L PS amounts, leukocyte and thrombocyte counts, plasma urea and creatini ne, and body temperature were measured for up to 8 days after surgery and tested for their value to detect anastomotic leaks. Results: LPS c oncentrations in the drainage fluid and daily excreted LPS amounts of patients with anastomotic leaks were significantly higher compared to the group without anastomotic leaks. On the third postoperative day, L PS concentrations ranged from 5270 to 6750 pg/ml in patients with anas tomotic leaks and from 1 to 1848 pg/ml in patients without complicatio ns. Total daily excreted LPS amounts were 270-675 ng/day in patients w ith anastomotic leak and 0-92 ng/day in patients without anastomotic l eaks. Both LPS-related parameters allowed reliable detection of anasto motic leaks on day 3 after surgery (Student's t-Test, p<0.0005), while leukocyte and thrombocyte counts, plasma urea and creatinine, and bod y temperatures of both patient groups were not significantly different at any time (p>0.05). Conclusion: We found that the measurement of LP S concentrations in the drainage and the daily excreted LPS amount cou ld be valuable parameters for the early detection of anastomotic leaks as early as on the third post-operative day.