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Meta-Analysis
. 2016 Aug;31(8):1409-17.
doi: 10.1007/s00384-016-2616-4. Epub 2016 Jun 13.

Is the intraoperative air leak test effective in the prevention of colorectal anastomotic leakage? A systematic review and meta-analysis

Zhouqiao Wu  1   2 , Remondus C J van de Haar  3 , Cloë L Sparreboom  3 , Geesien S A Boersema  3 , Ziyu Li  4 , Jiafu Ji  4 , Johannes Jeekel  5 , Johan F Lange  3   6
Affiliations
Meta-Analysis

Is the intraoperative air leak test effective in the prevention of colorectal anastomotic leakage? A systematic review and meta-analysis

Zhouqiao Wu et al. Int J Colorectal Dis. 2016 Aug.

Abstract

Objective: The intra-operative air leak test (ALT) is a common intraoperative test used to identify mechanically insufficient anastomosis. This meta-analysis aims to determine whether ALT aids to the reduction of postoperative colorectal anastomotic leakage (CAL).

Methods: A literature search was performed to select studies in acknowledged databases. Full text articles targeting ALT during colorectal surgery were included. Quality assessment, risk of bias, and the level-of-evidence of the inclusions were evaluated. ALT methodology, ALT(+) (i.e., leak observed during the test) rate, and postoperative CAL rate of the included studies were subsequently analyzed.

Results: Twenty studies were included for analysis, in which we found substantial risks of bias. A lower CAL rate was observed in patients who underwent ALT than those did not; however, the difference was not significant (p = 0.15). The intraoperative ALT(+) rate greatly varied among the included studies from 1.5 to 24.7 %. ALT(+) patients possessed a significantly higher CAL rate than the ALT(-) patients (11.4 vs. 4.2 %, p < 0.001).

Conclusions: Based on the available evidence, performing an ALT with the reported methodology has not significantly reduced the clinical CAL rate but remains necessary due to a higher risk of CAL in ALT(+) cases. Unfortunately, additional repairs under current methods may not effectively decrease this risk. Results of this review urge a standardization of ALT methodology and effective methods to repair ALT(+) anastomoses.

Keywords: Air leak test; Anastomotic leakage; Colorectal surgery; Prevention.

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Figures

Fig. 1
Fig. 1
Flow chart of the literature search according to the PRISMA guideline
Fig. 2
Fig. 2
Clinical colorectal anastomotic leakage rate in air leak test (ALT) patients vs. non-ALT patients
Fig. 3
Fig. 3
Clinical colorectal anastomotic leakage rate in air leak test (ALT) patients vs. non-ALT patients: subgroup analysis LOE 1b. LOE level of evidence
Fig. 4
Fig. 4
Clinical colorectal anastomotic leakage rate in air leak test (ALT) patients vs. non-ALT patients: subgroup analysis LOE 2b. LOE level of evidence
Fig. 5
Fig. 5
Intraoperative ALT (+) rate, postoperative CAL rate in ALT (+) cases, and overall postoperative CAL rate. Bars in blue indicate the intraoperative positive rate of the air leak test, i.e., ALT(+) rate; bars in red indicate the postoperative CAL rate in the ALT(+) patients; bars in green indicate the overall postoperative CAL rate in all the included patients in each study respectively. CAL colorectal anastomotic leakage, ALT air leak test, ALT(+) indicates that leak was observed during the test
Fig. 6
Fig. 6
Colorectal anastomotic leakage rate in ALT(+) patients vs. in ALT(−) patients. CAL colorectal anastomotic leakage, ALT air leak test, ALT air leak test, ALT(+) indicates that leak was observed during the test, ALT(−) indicates that no leak was observed during the test
See this image and copyright information in PMC

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