From the Guidelines
Complications of ELAPE are a significant concern, with pulmonary, infectious, and gastrointestinal complications being the most common, and cardiovascular and renal complications being highly predictive of mortality, emphasizing the need for proactive detection and management of physiological derangement and early management of complications. The most recent and highest quality study, 1, highlights the importance of ongoing monitoring and management of ongoing physiological derangement, early detection of complications, and avoidance of failure to rescue. Some of the key complications associated with ELAPE include:
- Pulmonary complications, such as postoperative hypoxemia and pulmonary complications related to atelectasis, diaphragmatic dysfunction, retained secretions, pain, and aspiration, which can be prevented with the use of noninvasive positive pressure ventilation (NIPPV) or continuous positive airway pressure (CPAP) immediately post-extubation, as recommended by the European Society for Anaesthesiology and Intensive Care and European Society of Intensive Care Medicine (ESA/ESICM) guidelines 1
- Infectious complications, such as deep space surgical site infection, which can be related to wound dehiscence, and can be prevented with the use of enhanced recovery pathways and prophylactic mucolytics, as suggested by a systematic review and meta-analysis of perioperative interventions to prevent postoperative pulmonary complications 1
- Gastrointestinal complications, such as nausea, vomiting, and ileus, which can be prevented with the use of goal-directed hemodynamic therapy and epidural analgesia, as recommended by the ESA/ESICM guidelines 1
- Cardiovascular complications, such as acute heart failure, which can be managed with the use of goal-directed medical therapies, including beta-blockers, angiotensin-converting enzyme inhibitors, and mineralocorticoid receptor antagonists, as recommended by the latest European guidelines for diagnosis and treatment of acute heart failure 1
- Renal complications, such as acute kidney injury, which can be prevented with the use of intravenous iron supplementation and careful fluid management, as recommended by the latest European guidelines for diagnosis and treatment of acute heart failure 1 The failure to rescue (FTR) rate is a critical factor in determining outcomes, and can be modifiable by institutional factors, such as higher nurse to patient ratios, and the use of rapid response teams, which include an intensivist experienced in management of postoperative surgical patients. Overall, the management of ELAPE complications requires a multidisciplinary approach, including anaesthesiologists, intensivists, surgeons, and cardiologists, and should prioritize the use of evidence-based guidelines and protocols to reduce morbidity, mortality, and improve quality of life.
From the Research
Complications of ELAPE
- Perineal hernia: observed in 1 patient 2
- Impaired sexual function: reported in 1 patient 2
- Parastomal hernias: occurred in 3 patients 2
- Local recurrence: rate of 1.9% 2
- Distant metastasis: noted in 12 patients 2
- Impotence: most frequently reported problem, with mean symptom scores of 89.7 and 78.8 for ELAPE and SAPE respectively 3
- Wound infection: rates of 7.1% and 7.3% reported in two different studies 4, 5
- Postoperative complications: such as colostomy-associated issues, intestinal obstruction, urinary retention, perineal wound complications, and chronic perineal pain, showed no significant difference between La-ELAPE and Op-ELAPE groups 6
Surgical Outcomes
- Operation time: mean of 213.5 minutes reported in one study 2
- Intraoperative blood loss: mean of 152.7 ml reported in one study 2
- Postoperative hospital stay: median of 12 days reported in one study 4, with La-ELAPE group having shorter stay compared to Op-ELAPE group 6
- Circumferential resection margin positivity: no significant difference between La-ELAPE and Op-ELAPE groups 6
- Intraoperative perforation: no significant difference between La-ELAPE and Op-ELAPE groups 6