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.
