The impact of anastomotic leakage characteristics on the occurrence of anastomotic stenosis after colorectal resection, a retrospective cohort study.

INTRODUCTION: Anastomotic stenosis (AS) is a common complication after colorectal resection. However, the predisposing factors for stricture formation are not fully understood. Previous studies have shown anastomotic leakage (AL) to be a risk factor for the occurrence of AS. Therefore, we aim to investigate the impact of anastomotic leakage characteristics on the occurrence of anastomotic stenosis after colorectal resection. METHODS: Consecutive patients with AL following elective, sphincter preserving, colorectal resection, with or without diversion ostomy, between January 2009 and March 2023 were identified from a prospectively collected database. The characteristics of the anastomotic leakage, patient baseline and operative characteristics as well as the postoperative outcomes were analyzed using univariate and multivariate logistic regression to identify factors associated with the occurrence of post-leakage AS. RESULTS: A total of 129 patients developed AL and met the inclusion criteria. Among these, 28 (21.7%) patients were diagnosed with post-leakage AS. There was a significantly higher frequency of patients with neoadjuvant radiotherapy (18% vs 3%; p = .026) and hand-sewn anastomoses (39% vs 17%; p = .011) within the AS group. Furthermore, the extent of the anastomotic defect was significantly higher in the AS group compared with the non-AS group (50%, IQR 27-71 vs. 20%, IQR 9-40, p = 0.011). Similar findings were observed between the study groups regarding age, sex, BMI, ASA score, medical comorbidities, diagnosis, surgical procedure, surgical approach (open vs. minimally invasive), and anastomotic fashioning (side-to-end vs. end-to-end). On multivariate analysis, the extent of the anastomotic defect (OR 1.01; 95% CI 1.00-1.03; p = 0.034) and hand-sewn anastomoses (OR 2.68; 95% CI 1.01-6.98; p = 0.043) were confirmed as independent risk factors for post-leakage AS. No correlation could be observed between the occurrence of post-leakage AS and the ISREC grading of AL, the anastomotic height or the management of AL. Time to ostomy reversal was significantly longer in the AS group (202d, IQR 169-275 vs. 318d IQR 192-416, p = 0.014). CONCLUSION: The extent of the anastomotic defect and hand-sewn anastomoses were confirmed as independent risk factors for the occurrence of post-leakage AS. No correlation could be observed between the ISREC grading of AL, the anastomotic height or AL management, and the occurrence of post-leakage AS.

Unknown Onset Stroke: Differences Between Patients with Wake-Up Stroke and Daytime-Unwitnessed Stroke.

OBJECTIVES: Patients with unknown onset stroke (UOS) can be categorized as wake-up stroke (WUS) and daytime-unwitnessed stroke (DUS). We sought to determine whether decisions for initial imaging modalities, frequency of mismatch findings, resulting treatment decisions and outcome differ between WUS and DUS patients. MATERIALS AND METHODS: In a retrospective analysis, all patients with UOS admitted to our Stroke Unit from January to December 2018 were evaluated and classified as either WUS or DUS. RESULTS: 180 patients were included (74.4 % WUS, 25.6 % DUS). Compared to WUS patients, DUS patients received more often a non-contrast computed tomography initially (43.5 % vs. 24.6 %, p = 0.016). MR imaging was performed more frequently in WUS patients (53.7 % vs. 34.8 %, p = 0.027). The rate of mismatch findings in patients examined with either multimodal CT or MRI (126 patients, 101 WUS and 26 DUS) did not differ between the groups. Likewise, the rate of intravenous thrombolysis or mechanical thrombectomy was similar in both groups. DUS patients had more often severe neurological deficits at admission as defined by the National Institutes of Stroke Scale score (14.2 vs. 8.6, p < 0.001). CONCLUSIONS: Patients with DUS had disadvantages in mismatch-based treatment options due to initial imaging modalities. Current data do not support different treatment concepts in WUS and DUS patients. All UOS patients should initially be evaluated by either multimodal CT or MRI to open a chance to receive reperfusion therapy.