Colorectal Infraperitoneal anastomosis: the effects of perioperative supplemental oxygen administration on the anastomotic dehiscence.

BACKGROUND

The role of supplemental oxygen therapy in the healing of colorectal anastomosis is still very much at an experimental stage. The aim of the present study, prospective randomized, was to assess the effect of administration of perioperative supplemental oxygen therapy on infraperitoneal anastomosis, where the risk of leakage is higher.

METHODS

We enrolled 72 patients between February, 2008 and February, 2011, who underwent elective open infraperitoneal anastomosis for rectal cancer (middle and low). Patients were assigned randomly to an oxygen/air mixture with a fraction of inspired oxygen (FiO2) of 30% (n = 37) or 80% (n = 35). Administration was commenced after induction of anesthesia and maintained for 6 h after surgery.

RESULTS

The overall anastomotic leak rate was 16.6% (12 out of 72); 8 patients (21.6%) had an anastomotic dehiscence in the 30% FiO2 group and 4 (11.4%) in the 80% FiO2 group (p < 0.05). The risk of anastomotic leak was 46% lower in the 80% FiO2 group (RR, 0.63; 95% confidence interval, 0.42–0.98) vs. the 30% FiO2.

CONCLUSION

Therefore, supplemental 80% FiO2 during and for 6 h after major rectal cancer surgery, reducing postoperative anastomotic dehiscence, should be considered part of ongoing quality improvement activities related to surgical care, with few risks to the patient and little associated cost.