COLORECTAL ANASTOMOSIS DEHISCENCE. MINIMALLY INVASIVE TREATMENT

Introduction Colorectal anastomosis dehiscence has decreased in recent decades with the introduction of new sutures and staplers, along with minimally invasive surgery and methods to assess anastomotic perfusion, such as fluorescence with Indocyanine Green, as well as devices and materials to reinforce the anastomosis. In benign diseases, unlike malignancies, the incidence of anastomotic dehiscence is low. However, when it occurs, it is a serious complication that increases hospital stays, reoperations, and infections.

Objective To demonstrate the use of minimally invasive procedures in patients who underwent colorectal anastomosis via laparoscopic or robotic surgery and experienced anastomotic dehiscence in benign diseases, such as acute diverticulitis and intestinal endometriosis.

Methods In a cohort of 1,170 patients who underwent laparoscopic and robotic surgeries for benign intestinal diseases from August 2016 to March 2024, our incidence of anastomotic fistula was 0.85%, compared to 0.92% to 1.98% reported in the literature. We will demonstrate through videos our approach using minimally invasive techniques to avoid laparotomies. Procedures included laparoscopic drainage puncture, lavage and drainage, resection with new anastomosis, colostomies, ileostomies, and endoscopic vacuum therapy, all accompanied by nutritional support via parenteral feeding.

Discussion The most commonly used approach for low-output anastomotic fistulas without significant general health implications is conservative treatment. However, in cases where this treatment fails or in the presence of peritonitis, wide laparotomies and diverting stomas are performed, increasing complications, hospital stays, infections, dehiscences, and hernias at the surgical incision site, as well as thromboembolic complications due to delayed early mobilization.

Conclusion It is important to individualize each case and apply minimally invasive approaches. Not all cases require reoperation, and not every reoperated case needs resection or a terminal stoma. Newer, minimally invasive treatments, such as endoscopic vacuum therapy, should always be considered. Our patients experienced less postoperative pain, fewer complications, a lower rate of surgical readmissions, and a faster return to their activities.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025