Management of Colorectal Anastomotic Leak

Abstract

The aim of this article is to present strategies for preventing and managing the failure of the surgical restoration of intestinal continuity. Despite improvements in surgical technique and perioperative care, anastomotic leaks still occur, and with them occur increased morbidity, mortality, length of stay, and costs. Due to the devastating consequences for patients with failed anastomoses, there have been a myriad of materials and techniques used by surgeons to create better intestinal anastomoses. We will also discuss the management strategies for anastomotic leak when they do inevitably occur.

Keywords

leak - anastomosis - testing - risk factors

• References

• 1 Dietz UA, Debus ES. Intestinal anastomoses prior to 1882; a legacy of ingenuity, persistence, and research form a foundation for modern gastrointestinal surgery. World J Surg 2005; 29 (3) 396-401
• 2 Peel AL, Taylor EW ; Surgical Infection Study Group. Proposed definitions for the audit of postoperative infection: a discussion paper. Ann R CollSurgEngl 1991; 73 (6) 385-388
• 3 Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg 2011; 253 (5) 890-899
• 4 Kingham TP, Pachter HL. Colonic anastomotic leak: risk factors, diagnosis, and treatment. J Am CollSurg 2009; 208 (2) 269-278
• 5 Boccola MA, Buettner PG, Rozen WM , et al. Risk factors and outcomes for anastomotic leakage in colorectal surgery: a single-institution analysis of 1576 patients. World J Surg 2011; 35 (1) 186-195
• 6 Stumpf M, Klinge U, Wilms A , et al. Changes of the extracellular matrix as a risk factor for anastomotic leakage after large bowel surgery. Surgery 2005; 137 (2) 229-234
• 7 Eriksen TF, Lassen CB, Gögenur I. Treatment with corticosteroids and the risk of anastomotic leakage following lower gastrointestinal surgery: a literature survey. Colorectal Dis 2014; 16 (5) O154-O160
• 8 Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 1998; 85 (3) 355-358
• 9 Appau KA, Fazio VW, Shen B , et al. Use of infliximab within 3 months of ileocolonic resection is associated with adverse postoperative outcomes in Crohn's patients. JGastrointestSurg 2008; 12 (10) 1738-1744
• 10 Kunitake H, Hodin R, Shellito PC, Sands BE, Korzenik J, Bordeianou L. Perioperative treatment with infliximab in patients with Crohn's disease and ulcerative colitis is not associated with an increased rate of postoperative complications. JGastrointestSurg 2008; 12 (10) 1730-1736 , discussion 1736–1737
• 11 Selvasekar CR, Cima RR, Larson DW , et al. Effect of infliximab on short-term complications in patients undergoing operation for chronic ulcerative colitis. J Am CollSurg 2007; 204 (5) 956-962 , discussion 962–963
• 12 Syed A, Cross RK, Flasar MH. Anti-tumor necrosis factor therapy is associated with infections after abdominal surgery in Crohn's disease patients. Am J Gastroenterol 2013; 108 (4) 583-593
• 13 Hakkarainen TW, Steele SR, Bastaworous A , et al. Nonsteroidal anti-inflammatory drugs and the risk for anastomotic failure: a report from Washington State's Surgical Care and Outcomes Assessment Program (SCOAP). JAMA Surg 2015; 150 (3) 223-228
• 14 Lin X, Li J, Chen W , et al. Diabetes and risk of anastomotic leakage after gastrointestinal surgery. JSurg Res 2015; 196 (2) 294-301
• 15 Shikata S, Yamagishi H, Taji Y, Shimada T, Noguchi Y. Single- versus two- layer intestinal anastomosis: a meta-analysis of randomized controlled trials. BMC Surg 2006; 6: 2
• 16 Kennedy R, Jenkins I, Finan PJ. Controversial topics in surgery: splenic flexure mobilisation for anterior resection performed for sigmoid and rectal cancer. Ann R CollSurgEngl 2008; 90 (8) 638-642
• 17 Hüttner FJ, Tenckhoff S, Jensen K , et al. Meta-analysis of reconstruction techniques after low anterior resection for rectal cancer. Br J Surg 2015; 102 (7) 735-745
• 18 Ikeda T, Kumashiro R, Oki E , et al. Evaluation of techniques to prevent colorectal anastomotic leakage. JSurg Res 2015; 194 (2) 450-457
• 19 Kim IY, Kim BR, Kim YW. Applying reinforcing sutures to stapled colorectal anastomosis after low anterior resection for rectal cancer. Eur J SurgOncol 2015; 41 (6) 808-809
• 20 Beard JD, Nicholson ML, Sayers RD, Lloyd D, Everson NW. Intraoperative air testing of colorectal anastomoses: a prospective, randomized trial. Br J Surg 1990; 77 (10) 1095-1097
• 21 Ricciardi R, Roberts PL, Marcello PW, Hall JF, Read TE, Schoetz DJ. Anastomotic leak testing after colorectal resection: what are the data?. Arch Surg 2009; 144 (5) 407-411 , discussion 411–412
• 22 Ris F, Hompes R, Cunningham C , et al. Near-infrared (NIR) perfusion angiography in minimally invasive colorectal surgery. SurgEndosc 2014; 28 (7) 2221-2226
• 23 Jafari MD, Wexner SD, Martz JE , et al. Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II): a multi-institutional study. J Am CollSurg 2015; 220 (1) 82-92.e1
• 24 Kin C, Vo H, Welton L, Welton M. Equivocal effect of intraoperative fluorescence angiography on colorectal anastomotic leaks. Dis Colon Rectum 2015; 58 (6) 582-587
• 25 Hüser N, Michalski CW, Erkan M , et al. Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg 2008; 248 (1) 52-60
• 26 Tan WS, Tang CL, Shi L, Eu KW. Meta-analysis of defunctioning stomas in low anterior resection for rectal cancer. Br J Surg 2009; 96 (5) 462-472
• 27 Habib K, Gupta A, White D, Mazari FA, Wilson TR. Utility of contrast enema to assess anastomotic integrity and the natural history of radiological leaks after low rectal surgery: systematic review and meta-analysis. Int J Colorectal Dis 2015; 30 (8) 1007-1014
• 28 den Dulk M, Noter SL, Hendriks ER , et al. Improved diagnosis and treatment of anastomotic leakage after colorectal surgery. Eur J SurgOncol 2009; 35 (4) 420-426
• 29 Kumar RR, Kim JT, Haukoos JS , et al. Factors affecting the successful management of intra-abdominal abscesses with antibiotics and the need for percutaneous drainage. Dis Colon Rectum 2006; 49 (2) 183-189
• 30 Phitayakorn R, Delaney CP, Reynolds HL , et al; International Anastomotic Leak Study Group. Standardized algorithms for management of anastomotic leaks and related abdominal and pelvic abscesses after colorectal surgery. World J Surg 2008; 32 (6) 1147-1156
• 31 Sirois-Giguère E, Boulanger-Gobeil C, Bouchard A , et al. Transanal drainage to treat anastomotic leaks after low anterior resection for rectal cancer: a valuable option. Dis Colon Rectum 2013; 56 (5) 586-592
• 32 Abbas MA. Endoscopic management of acute colorectal anastomotic complications with temporary stent. JSLS 2009; 13 (3) 420-424
• 33 Lamazza A, Sterpetti AV, De Cesare A, Schillaci A, Antoniozzi A, Fiori E. Endoscopic placement of self-expanding stents in patients with symptomatic anastomotic leakage after colorectal resection for cancer: long-term results. Endoscopy 2015; 47 (3) 270-272
• 34 Glitsch A, von Bernstorff W, Seltrecht U, Partecke I, Paul H, Heidecke CD. Endoscopic transanal vacuum-assisted rectal drainage (ETVARD): an optimized therapy for major leaks from extraperitoneal rectal anastomoses. Endoscopy 2008; 40 (3) 192-199
• 35 Weidenhagen R, Gruetzner KU, Wiecken T, Spelsberg F, Jauch KW. Endoluminal vacuum therapy for the treatment of anastomotic leakage after anterior rectal resection. RozhlChir 2008; 87 (8) 397-402
• 36 Arezzo A, Verra M, Passera R, Bullano A, Rapetti L, Morino M. Long-term efficacy of endoscopic vacuum therapy for the treatment of colorectal anastomotic leaks. Dig Liver Dis 2015; 47 (4) 342-345
• 37 Fraccalvieri D, Biondo S, Saez J , et al. Management of colorectal anastomotic leakage: differences between salvage and anastomotic takedown. Am J Surg 2012; 204 (5) 671-676
• 38 Rickert A, Willeke F, Kienle P, Post S. Management and outcome of anastomotic leakage after colonic surgery. Colorectal Dis 2010; 12 (10 Online): e216-e223
• 39 Lee CM, Huh JW, Yun SH , et al. Laparoscopic versus open reintervention for anastomotic leakage following minimally invasive colorectal surgery. SurgEndosc 2015; 29 (4) 931-936