A bioelectronic approach to post-surgical anastomotic leakage diagnosis

  • Joshua Paulinus

Student thesis: Doctoral Thesis


Colorectal cancer is a disease that afflicts a substantial number of people globally. One of the methods of removing the cancer is to surgically resect the tumourous section. In many cases, the remaining healthy sections of the colon/rectum are reattached to form what is known as an anastomosis. In some cases, this anastomosis can leak, often referred to anastomotic leakage, leading to longer hospital stays and costs and can lead to patient mortality if not detected and treated at an early stage. However, there is no universal method of detecting anastomotic leakage at an early stage, with clinicians often requiring patients to exhibit symptoms before even suspecting anastomotic leakage, which is often too late for diagnosis. Delays in diagnosis has been shown to increase the likelihood of patient mortality, therefore the aim of this thesis was to determine a method of detecting anastomotic leakage reliably at an early stage. Glucose, lactate and pH, as well as electrochemical diagnostic techniques (electrochemical impedance spectroscopy - EIS and cyclic voltammetry - CV) were used to investigate their usefulness in indicating anastomotic leakage. Initially, methods needed to be developed to allow for testing of patient peritoneal fluid. Glucose and lactate commercial assays were modified for use with these samples and found to have a linear region of up to 20mM for lactate and 25mM for glucose. EIS and CV techniques were also developed using platinum working and counter electrodes. Initially, these techniques were tested with a simulated wound fluid and indicated the need for a fixed volume for testing. Further testing with a more complex simulated fluid that is more similar to the expected patient samples. When spiked with bacteria and blood, EIS showed its potential at distinguishing between differing components of the fluid whereas results from CV indicated a lower utility for clinical monitoring. Methods which were developed and tested were then used on patient samples. Though no useful data was collected with regards to anastomotic leakage, other useful information about patients who underwent an uncomplicated post-op and some on patients who experienced other post-op complications was gained. Glucose was found to peak at shortly after surgery and drop over time with a strong trend being determined. In addition, some of the patients who had post-op condition caused anomalous results which could indicate its potential at determining post-op conditions. EIS results also showed potential with determining other post-op complications. However, lactate, pH and CV showed to be of limited/no use of diagnosing post-op conditions. Further work in the area should focus on larger scale studies looking at glucose and EIS as well as performing micro-biology studies to confirm trends in this thesis.
Date of Award1 Jun 2021
Original languageEnglish
Awarding Institution
  • University Of Strathclyde
SponsorsEPSRC (Engineering and Physical Sciences Research Council)
SupervisorPatricia Connolly (Supervisor) & Richard Anthony Black (Supervisor)

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