Is Peritoneal Drain pH an Indicator of Anastomotic Leakage in Colorectal Surgery?

Introduction:Early diagnosis of Anastomotic Leakage (AL) after Colorectal surgery is essential to reduce patient's morbidity and mortality.The current diagnostic strategy, consisting of clinical evaluation, blood tests and on-demand CT scanning, may fail to detect AL at an early stage.An innovative approach lies in evaluating biomarkers from the immediate environment of the anastomosis, such as pH value, lactate value and base deficit through peritoneal fluid sampling, that might offer the potential to achieve earlier and more specific AL detection than current methods.Methods: In our study, peritoneal lactate, pH and base deficit, collected from the drain fluid for the first 5 postoperative days, were analyzed from 137 patients undergoing colectomy with a primary anastomosis for any colon or rectal pathology within 1 year. Results:Mean pH values of drain fluid collected from patients developing AL had a statistically significant difference when compared to those without AL.Patients with AL demonstrated a consistent tendency to decrease, whereas patients without AL showed a stable and rising pattern.On the other hand, the results obtained from lactate and base deficit were not useful for prediction.Discussion: Timing diagnosis of AL is of paramount importance in order to reduce morbidity and mortality.The goal is not necessarily to entirely prevent its occurrence, but rather to establish a cautious postoperative course.PH from the peritoneal drain sample seems able to predict AL in advance of its clinical presentation. Conclusion:PH value of the perianastomotic drainage fluid after colorectal operations with anastomosis, may be a cheap, noninvasive and useful biomarker to identify AL early.