Abstract
Anastomotic leak is associated with increased morbidity and mortality after colorectal
surgery. Although surgical techniques have improved over time, anastomotic leak is
still a reality in colorectal surgery with rates ranging from as low as 1% for low-risk
anastomoses, such as enteroenteric or ileocolic, to 19% for high-risk coloanal anastomoses.
There are many varied risk factors for anastomotic leak. However, many of the risk
factors have not been definitively proven in high-quality studies. Presumably, risk
factors are cumulative and every effort should be made to optimize modifiable risk
factors in the perioperative period. Treatment of anastomotic leak should start with
the determination of patient stability followed by resuscitation and diagnostic imaging
or operative exploration. Operative findings will dictate surgical approach with the
goal of controlling sepsis and stabilizing the patient. If nonoperative treatment
is undertaken, close patient monitoring is necessary to ensure control of sepsis and
that intervention is undertaken if the clinical picture changes. Early intervention
at each stage is key to decreasing the morbidity of anastomotic leak.
Keywords
anastomosis - leak - sepsis - drainage - exploration
