Background: Anastomotic leaks (AL) are a deadly postoperative complication. This study evaluated the efficacy of Stream TM Platform, a medical device designed to provide early prediction of AL using changes in peritoneal fluid pH and electrical conductivity (EC). Methods : Stream TM Platform was attached to the JP drain of 17 Yorkshire pigs, continuously measuring pH and EC or peritoneal effluent in a model of colorectal AL. Anastomotic leaks were surgically induced and confirmed through re-laparotomy. Results: Significant differences in pH were observed between experimental and sham animals two hours following leak induction via continuous measurements ( P = 0.02857), at the 24-hour time point in reservoir fluid ( P = 0.008), and during final peritoneal fluid collection at re-laparotomy ( P = 0.024). Conclusion: This study illustrates the potential of continuous pH monitoring for early detection of anastomotic leaks, using a non-invasive technology— Stream TM Platform—in a model that closely resembles human physiology.
Thomas, M. and Margolin, D. (2016) Management of Colorectal Anastomotic Leak. Clinics in Colon and Rectal Surgery , 29, 138-144. https://doi.org/10.1055/s-0036-1580630
Kingham, P.T. and Pachter, L.H. (2009) Colonic Anastomotic Leak: Risk Factors, Diagnosis, and Treatment. Journal of the American College of Surgeons , 208, 269-278. https://doi.org/10.1016/j.jamcollsurg.2008.10.015
Tsai, Y. and Chen, W.T. (2019) Management of Anastomotic Leakage after Rectal Surgery: A Review Article. Journal of Gastrointestinal Oncology , 10, 1229-1237. https://doi.org/10.21037/jgo.2019.07.07
Awad, S., El-Rahman, A.I.A., Abbas, A., Althobaiti, W., Alfaran, S., Alghamdi, S., et al . (2021) The Assessment of Perioperative Risk Factors of Anastomotic Leakage after Intestinal Surgeries; a Prospective Study. BMC Surgery , 21, Article No. 29. https://doi.org/10.1186/s12893-020-01044-8
Goshen-Gottstein, E., Shapiro, R., Shwartz, C., et al . (2019) Incidence and Risk Factors for Anastomotic Leakage in Colorectal Surgery: A Historical Cohort Study. The Israel Medical Association Journal , 21, 732-737.
Telem, D.A., Chin, E.H., Nguyen, S.Q. and Divino, C.M. (2010) Risk Factors for Anastomotic Leak Following Colorectal Surgery: A Case-Control Study. Archives of Surgery , 145, 371-376. https://doi.org/10.1001/archsurg.2010.40
Li, Y., Lian, P., Huang, B., Zheng, H., Wang, M., Gu, W., et al . (2017) Very Early Colorectal Anastomotic Leakage within 5 Post-Operative Days: A More Severe Subtype Needs Relaparatomy. Scientific Reports , 7, Article No. 39936. https://doi.org/10.1038/srep39936
Gessler, B., Eriksson, O. and Angenete, E. (2017) Diagnosis, Treatment, and Consequences of Anastomotic Leakage in Colorectal Surgery. International Journal of Colorectal Disease , 32, 549-556. https://doi.org/10.1007/s00384-016-2744-x
Meyer, J., Naiken, S., Christou, N., Liot, E., Toso, C., Buchs, N.C., et al . (2019) Reducing Anastomotic Leak in Colorectal Surgery: The Old Dogmas and the New Challenges. World Journal of Gastroenterology , 25, 5017-5025. https://doi.org/10.3748/wjg.v25.i34.5017
Marres, C.C.M., van de Ven, A.W.H., Leijssen, L.G.J., Verbeek, P.C.M., Bemelman, W.A. and Buskens, C.J. (2017) Colorectal Anastomotic Leak: Delay in Reintervention after False-Negative Computed Tomography Scan Is a Reason for Concern. Techniques in Coloproctology , 21, 709-714. https://doi.org/10.1007/s10151-017-1689-6
Kornmann, V.N.N., van Ramshorst, B., Smits, A.B., Bollen, T.L. and Boerma, D. (2013) Beware of False-Negative CT Scan for Anastomotic Leakage after Colonic Surgery. International Journal of Colorectal Disease , 29, 445-451. https://doi.org/10.1007/s00384-013-1815-5
Kornmann, V.N.N., Treskes, N., Hoonhout, L.H.F., Bollen, T.L., van Ramshorst, B. and Boerma, D. (2012) Systematic Review on the Value of CT Scanning in the Diagnosis of Anastomotic Leakage after Colorectal Surgery. International Journal of Colorectal Disease , 28, 437-445. https://doi.org/10.1007/s00384-012-1623-3
Gray, M., Marland, J.R.K., Murray, A.F., Argyle, D.J. and Potter, M.A. (2021) Predictive and Diagnostic Biomarkers of Anastomotic Leakage: A Precision Medicine Approach for Colorectal Cancer Patients. Journal of Personalized Medicine , 11, Article 471. https://doi.org/10.3390/jpm11060471
Hyman, N., Manchester, T.L., Osler, T., Burns, B. and Cataldo, P.A. (2007) Anastomotic Leaks after Intestinal Anastomosis: It’s Later Than You Think. Annals of Surgery , 245, 254-258. https://doi.org/10.1097/01.sla.0000225083.27182.85
Barzola, E., Planellas, P., Torres-Acevedo, N. and Bergamaschi, R. (2024) Perioperative Assessment of Colorectal Anastomoses with Flexible Endoscopy. Updates in Surgery , 77, 139-142. https://doi.org/10.1007/s13304-024-02046-4
Smith, S.R., Pockney, P., Holmes, R., Doig, F., Attia, J., Holliday, E., et al . (2017) Biomarkers and Anastomotic Leakage in Colorectal Surgery: C-Reactive Protein Trajectory Is the Gold Standard. ANZ Journal of Surgery , 88, 440-444. https://doi.org/10.1111/ans.13937
Yang, L., Huang, X., Xu, L., Zhou, X., Zhou, J., Yu, D., et al . (2013) Acidic Pelvic Drainage as a Predictive Factor for Anastomotic Leakage after Surgery for Patients with Rectal Cancer. Asian Pacific Journal of Cancer Prevention , 14, 5441-5447. https://doi.org/10.7314/apjcp.2013.14.9.5441
Millan, M., García-Granero, E., Flor, B., García-Botello, S. and Lledo, S. (2006) Early Prediction of Anastomotic Leak in Colorectal Cancer Surgery by Intramucosal Ph. Diseases of the Colon & Rectum , 49, 595-601. https://doi.org/10.1007/s10350-006-0504-7
Molinari, E., Giuliani, T., Andrianello, S., Talamini, A., Tollini, F., Tedesco, P., et al . (2020) Drain Fluid’s pH Predicts Anastomotic Leak in Colorectal Surgery: Results of a Prospective Analysis of 173 Patients. Minerva Chirurgica , 75, 30-36. https://doi.org/10.23736/s0026-4733.19.08018-0
DeArmond, D.T., Cline, A.M. and Johnson, S.B. (2010) Anastomotic Leak Detection by Electrolyte Electrical Resistance. Journal of Investigative Surgery , 23, 197-203. https://doi.org/10.3109/08941930903469458
Ben-David, M., Carmeli, I., Orgad, R., Nathansohn-Levi, B., Yered, T., Shor, E., et al . (2022) Implantation of an Impedance Sensor for Early Detection of Gastrointestinal Anastomotic Leaks. Journal of Surgical Research , 278, 49-56. https://doi.org/10.1016/j.jss.2022.04.041
Turrentine, F.E., Denlinger, C.E., Simpson, V.B., Garwood, R.A., Guerlain, S., Agrawal, A., et al . (2015) Morbidity, Mortality, Cost, and Survival Estimates of Gastrointestinal Anastomotic Leaks. Journal of the American College of Surgeons , 220, 195-206. https://doi.org/10.1016/j.jamcollsurg.2014.11.002
Buchs, N.C., Gervaz, P., Secic, M., Bucher, P., Mugnier-Konrad, B. and Morel, P. (2007) Incidence, Consequences, and Risk Factors for Anastomotic Dehiscence after Colorectal Surgery: A Prospective Monocentric Study. International Journal of Colorectal Disease , 23, 265-270. https://doi.org/10.1007/s00384-007-0399-3
Ashraf, S.Q., Burns, E.M., Jani, A., Altman, S., Young, J.D., Cunningham, C., et al . (2013) The Economic Impact of Anastomotic Leakage after Anterior Resections in English NHS Hospitals: Are We Adequately Remunerating Them? Colorectal Disease , 15, e190-e198. https://doi.org/10.1111/codi.12125
Hammond, J., Lim, S., Wan, Y., Gao, X. and Patkar, A. (2014) The Burden of Gastrointestinal Anastomotic Leaks: An Evaluation of Clinical and Economic Outcomes. Journal of Gastrointestinal Surgery , 18, 1176-1185. https://doi.org/10.1007/s11605-014-2506-4
Gregg, C., Siegle, L. and Clarke, T. (2020) Monitoring Livestock Vital Signs. https://www.pubs.ext.vt.edu/APSC/APSC-169/APSC-169.html
Walshaw, J., Hugh, K., Helliwell, J., Burke, J. and Jayne, D. (2025) Perianastomotic Ph Monitoring for Early Detection of Anastomotic Leaks in Gastrointestinal Surgery: A Systematic Review of the Literature. Surgical Innovation , 32, 180-195. https://doi.org/10.1177/15533506241313168
Ge, W., Gong, H., Xia, Y., Shao, L., Shen, H. and Chen, G. (2021) Bacteriological Concentration of Peritoneal Drainage Fluid Could Make an Early Diagnosis of Anastomotic Leakage Following Rectal Resection. Scientific Reports , 11, Article No. 23156. https://doi.org/10.1038/s41598-021-02649-6
Gong, J., Yang, L., Huang, X., Sun, B., Zhou, J., Yu, D., et al . (2014) Outcomes Based on Risk Assessment of Anastomotic Leakage after Rectal Cancer Surgery. Asian Pacific Journal of Cancer Prevention , 15, 707-712. https://doi.org/10.7314/apjcp.2014.15.2.707
McCord, J.M. and Roy, R.S. (1982) The Pathophysiology of Superoxide: Roles in Inflammation and Ischemia. Canadian Journal of Physiology and Pharmacology , 60, 1346-1352. https://doi.org/10.1139/y82-201
Bellocq, A., Suberville, S., Philippe, C., Bertrand, F., Perez, J., Fouqueray, B., et al . (1998) Low Environmental Ph Is Responsible for the Induction of Nitric-Oxide Synthase in Macrophages. Evidence for Involvement of Nuclear Factor- κ B Activation. Journal of Biological Chemistry , 273, 5086-5092. https://doi.org/10.1074/jbc.273.9.5086
Dahlén, S.E., Björk, J., Hedqvist, P., Arfors, K.E., Hammarström, S., Lindgren, J.A., et al . (1981) Leukotrienes Promote Plasma Leakage and Leukocyte Adhesion in Postcapillary Venules: In Vivo Effects with Relevance to the Acute Inflammatory Response. Proceedings of the National Academy of Sciences of the United States of America , 78, 3887-3891. https://doi.org/10.1073/pnas.78.6.3887
Hackam, D.J., Grinstein, S., Nathens, A., Watson, W.G., Marshall, J.C. and Rotstein, O.D. (1996) Exudative Neutrophils Show Impaired Ph Regulation Compared with Circulating Neutrophils. Archives of Surgery , 131, 1296-1301. https://doi.org/10.1001/archsurg.1996.01430240050006
Benz, M., Werz, O., Jacob, R. and Steinhilber, D. (1997) Ph-dependent Regulation of Leukocyte 5-Lipoxygenase Activity in Inflammatory Exudates by Albumin. Inflammation Research , 46, 366-372. https://doi.org/10.1007/s000110050203
Filep, J.G. (2022) Targeting Neutrophils for Promoting the Resolution of Inflammation. Frontiers in Immunology , 13, Article 866747. https://doi.org/10.3389/fimmu.2022.866747