{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T01:53:01Z","timestamp":1790992381555,"version":"4.1.0"},"reference-count":22,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Anastomotic leak (AL) is the anathema of colorectal surgery. Early diagnosis is important to enable early intervention. Temporary diverting ileostomy (TDI) does not prevent AL and presents inherent complications. Numerous drain fluid biomarkers have been studied in colorectal surgery and extravasated intraluminal substances such as lipase have shown promise. The aim of this study was to assess drain fluid lipase (DFL) as a biomarker of AL after rectal resection with low colorectal anastomosis and no TDI.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This prospective observational cohort study collected samples of DFL in consecutive patients undergoing rectal resection with low colorectal anastomosis and without TDI. Data were collected and analysed relating to patient demographics, operation, indication, and daily DFL measurements from pelvic drains.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Between August 2018 and March 2021, there were 62 patients recruited who met eligibility criteria. Overall, the anastomotic leak rate was 9.7% (6\/62). These six patients were assigned to the AL group. The DFL on postoperative day 3 was found to be higher in the AL group compared to the NAL group (\n p<\/jats:italic>\n \u2009=\u20090.034). A DFL cutoff threshold of less than 64\u2009U\/L was found to have a negative predictive value of 97.6% and a negative likelihood ratio of 0.32 in excluding AL.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n This is the first study to assess the utility of DFL as a biomarker for AL following colorectal anastomosis without TDI. The measurement of DFL has value as a strong negative predictor of AL and moderate impact on post\u2010test probability. The results are comparable to the use of systemic biomarkers.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/ans.70975","type":"journal-article","created":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T01:06:10Z","timestamp":1790989570000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Drain Fluid Lipase as a Biomarker for Anastomotic Leak After Colorectal Resection and an Extra\u2010Peritoneal Anastomosis With Omission of a Diverting Ileostomy"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0938-7016","authenticated-orcid":false,"given":"Muhammad Imran","family":"Aumeerally","sequence":"first","affiliation":[{"name":"Department of Surgery Royal Brisbane and Women's Hospital Herston Australia"},{"name":"Faculty of Medicine University of Queensland Herston Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3794-3796","authenticated-orcid":false,"given":"Imogen","family":"Clark","sequence":"additional","affiliation":[{"name":"College of Medicine James Cook University Douglas Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2065-3012","authenticated-orcid":false,"given":"David Alan","family":"Clark","sequence":"additional","affiliation":[{"name":"Department of Surgery Royal Brisbane and Women's Hospital Herston Australia"},{"name":"Faculty of Medicine University of Queensland Herston Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,2]]},"reference":[{"issue":"5","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1002\/bjs.9697","article-title":"Systematic Review of Preoperative, Intraoperative and Postoperative Risk Factors for Colorectal Anastomotic Leaks","volume":"102","author":"McDermott F. D.","year":"2015","journal-title":"British Journal of Surgery"},{"issue":"8","key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1097\/DCR.0000000000000822","article-title":"Management of Low Colorectal Anastomotic Leakage in the Laparoscopic Era: More Than a Decade of Experience","volume":"60","author":"Boyce S. A.","year":"2017","journal-title":"Diseases of the Colon and Rectum"},{"issue":"5","key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1002\/bjs.10487","article-title":"Systematic Review of the Role of Biomarkers in Diagnosing Anastomotic Leakage Following Colorectal Surgery","volume":"104","author":"Su'a B. U.","year":"2017","journal-title":"British Journal of Surgery"},{"issue":"11","key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"2795","DOI":"10.1111\/codi.15844","article-title":"An Umbrella Systematic Review of Drain Fluid Analysis in Colorectal Surgery for the Detection of Anastomotic Leak: Not Yet Ready to Translate Research Studies Into Clinical Practice","volume":"23","author":"Clark D. A.","year":"2021","journal-title":"Colorectal Disease"},{"issue":"5","key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"337","DOI":"10.3393\/ac.2020.09.14.1","article-title":"Geographical Variation in the Use of Diverting Loop Ileostomy in Australia and New Zealand Colorectal Surgeons","volume":"37","author":"Clark D. A.","year":"2021","journal-title":"Annals of Coloproctology"},{"issue":"3","key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1097\/SLA.0000000000001991","article-title":"To Drain or Not to Drain Infraperitoneal Anastomosis After Rectal Excision for Cancer: The GRECCAR 5 Randomized Trial","volume":"265","author":"Denost Q.","year":"2017","journal-title":"Annals of Surgery"},{"issue":"11","key":"e_1_2_11_8_1","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1007\/s00384-017-2891-8","article-title":"Prophylactic Pelvic Drainage After Rectal Resection With Extraperitoneal Anastomosis: Is It Worthwhile? A Meta\u2010Analysis of Randomized Controlled Trials","volume":"32","author":"Menahem B.","year":"2017","journal-title":"International Journal of Colorectal Disease"},{"issue":"4","key":"e_1_2_11_9_1","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1111\/codi.14536","article-title":"Drain Fluid Amylase as a Sensitive Biomarker for the Early Detection of Anastomotic Leakage in Ileal Pouch Surgery","volume":"21","author":"Clark D. A.","year":"2019","journal-title":"Colorectal Disease"},{"issue":"4","key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1111\/ans.17461","article-title":"Drain Fluid Amylase as a Biomarker for the Detection of Anastomotic Leakage After Rectal Resection Without a Diverting Ileostomy","volume":"92","author":"Clark D. A.","year":"2022","journal-title":"ANZ Journal of Surgery"},{"issue":"2","key":"e_1_2_11_11_1","doi-asserted-by":"crossref","DOI":"10.1111\/codi.70031","article-title":"Drain Fluid Iodine as a Biomarker of Anastomotic Leak After Low Anterior Resection in Patients Undergoing Gastrografin Rectal Tube Flushes and Omission of a Diverting Ileostomy: The GUSH Study","volume":"27","author":"Clark D. A.","year":"2025","journal-title":"Colorectal Disease"},{"issue":"11","key":"e_1_2_11_12_1","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1097\/DCR.0000000000002376","article-title":"Multicenter Study of Drain Fluid Amylase as a Biomarker for the Detection of Anastomotic Leakage After Ileal Pouch Surgery Without a Diverting Ileostomy","volume":"65","author":"Clark D. 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L.","year":"2016","journal-title":"Gastroenterology Research and Practice"},{"issue":"2","key":"e_1_2_11_19_1","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1111\/codi.12411","article-title":"Systematic Review of Methods to Predict and Detect Anastomotic Leakage in Colorectal Surgery","volume":"16","author":"Hirst N. A.","year":"2014","journal-title":"Colorectal Disease"},{"issue":"2","key":"e_1_2_11_20_1","doi-asserted-by":"crossref","first-page":"14","DOI":"10.4240\/wjgs.v6.i2.14","article-title":"Prediction and Diagnosis of Colorectal Anastomotic Leakage: A Systematic Review of Literature","volume":"6","author":"Daams F.","year":"2014","journal-title":"World Journal of Gastrointestinal Surgery"},{"issue":"3","key":"e_1_2_11_21_1","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/j.amjsurg.2013.09.024","article-title":"Acute Phase Proteins in Drain Fluid: A New Screening Tool for Colorectal Anastomotic Leakage? The APPEAL Study: Analysis of Parameters Predictive for Evident Anastomotic Leakage","volume":"208","author":"Komen N.","year":"2014","journal-title":"American Journal of Surgery"},{"issue":"6","key":"e_1_2_11_22_1","doi-asserted-by":"crossref","DOI":"10.3390\/jcm14062099","article-title":"C\u2010Reactive Protein in Peritoneal Fluid for Predicting Anastomotic Leakage After Colorectal Cancer Surgery: A Systematic Review and Meta\u2010Analysis","volume":"14","author":"Vun T.","year":"2025","journal-title":"Journal of Clinical Medicine"},{"issue":"2","key":"e_1_2_11_23_1","doi-asserted-by":"crossref","first-page":"O35","DOI":"10.1111\/codi.12491","article-title":"To Drain or Not to Drain Extraperitoneal Colorectal Anastomosis? 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