ORIGINAL ARTICLE   

Minerva Chirurgica 2020 February;75(1):30-6

DOI: 10.23736/S0026-4733.19.08018-0

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Drain fluid’s pH predicts anastomotic leak in colorectal surgery: results of a prospective analysis of 173 patients

Enrico MOLINARI ¹, Tommaso GIULIANI ² ✉, Stefano ANDRIANELLO ², Alberto TALAMINI ¹, Filippo TOLLINI ¹, Pietro TEDESCO ¹, Paola PIRANI ¹, Francesca PANZERI ¹, Roberto SANDRINI ¹, Andrea REMO ³, Ernesto LATERZA ¹

¹ Department of General Surgery, ULSS9 Scaligera, Mater Salutis Hospital, Legnago, Verona, Italy; ² Department of General and Pancreatic Surgery, University of Verona Hospital Trust, Verona, Italy; ³ Department of Pathology, ULLS9 Scaligera, Mater Salutis Hospital, Legnago, Verona, Italy

BACKGROUND: The early risk assessment of anastomotic leak (AL) after colorectal surgery is crucial. Several markers have been proposed, including peritoneal fluid’s pH. Aim of the present study is to evaluate the role of drain fluid pH as predictor of AL.
METHODS: All patients undergoing colorectal surgery from January 2015 to December 2017 were considered eligible. Hartmann procedures, procedures including temporary ileostomy and emergency surgery were excluded. Drain fluid was submitted for pH and chemical-physical assessment on postoperative day 1 (POD1) and postoperative day 3 (POD3).
RESULTS: Out of 173 patients, those who developed AL showed a lower drain fluid’s pH on POD1 and on POD3 compared to patients who did not (P<0.05). The plotted ROC curves identified 7.53 as pH cut-off on POD1 (AUC 0.80) and 7.21 on POD3 (AUC 0.86). With both the cut-offs, pH was an independent predictor of AL at multivariable analysis (P<0.001). pH<7.53 on POD1 and pH<7.21 on POD3 showed 93.75% sensitivity and 97% specificity respectively.
CONCLUSIONS: Drain fluid’s pH on POD1 is useful to select patients who will not develop AL while on POD3 it might identify those requiring a more careful management.

KEY WORDS: Colorectal surgery; Anastomotic leak; Hydrogen-ion concentration; Fistula; Biomarkers; Drainage