Download PDF
Clin Colon Rectal Surg 2021; 34(06): 400-405
DOI: 10.1055/s-0041-1735271
Review Article

Management of Acute Anastomotic Leaks

Traci L. Hedrick
1   Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
,
William Kane
1   Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Management of the acute anastomotic leak is complex and patient-specific. Clinically stable patients often benefit from a nonoperative approach utilizing antibiotics with or without percutaneous drainage. Clinically unstable patients or nonresponders to conservative management require operative intervention. Surgical management is dictated by the degree of contamination and inflammation but includes drainage with proximal diversion, anastomotic resection with end-stoma creation, or reanastomosis with proximal diversion. Newer therapies, including colorectal stenting, vacuum-assisted rectal drainage, and endoscopic clipping, have also been described.

Keywords

anastomotic leak - colorectal surgery - colostomy - ileostomy - endoscopy


Publication History

Article published online:
01 October 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Marres CCM, van de Ven AWH, Leijssen LGJ, Verbeek PCM, Bemelman WA, Buskens CJ. Colorectal anastomotic leak: delay in reintervention after false-negative computed tomography scan is a reason for concern. Tech Coloproctol 2017; 21 (09) 709-714
    CrossrefPubMedGoogle Scholar
  • 2 Elagili F, Stocchi L, Ozuner G, Dietz DW, Kiran RP. Outcomes of percutaneous drainage without surgery for patients with diverticular abscess. Dis Colon Rectum 2014; 57 (03) 331-336
    CrossrefPubMedGoogle Scholar
  • 3 Siewert B, Tye G, Kruskal J. et al. Impact of CT-guided drainage in the treatment of diverticular abscesses: size matters. AJR Am J Roentgenol 2006; 186 (03) 680-686
    CrossrefPubMedGoogle Scholar
  • 4 Reed T, Economon D, Wiersema-Bryant L. Colocutaneous fistula management in a dehisced wound: a case study. Ostomy Wound Manage 2006; 52 (04) 60-64 , 66
    PubMedGoogle Scholar
  • 5 Sawyer RG, Claridge JA, Nathens AB. et al; STOP-IT Trial Investigators. Trial of short-course antimicrobial therapy for intraabdominal infection. N Engl J Med 2015; 372 (21) 1996-2005
    CrossrefPubMedGoogle Scholar
  • 6 Okita Y, Mohri Y, Kobayashi M. et al. Factors influencing the outcome of image-guided percutaneous drainage of intra-abdominal abscess after gastrointestinal surgery. Surg Today 2013; 43 (10) 1095-1102
    CrossrefPubMedGoogle Scholar
  • 7 Khurrum Baig M, Hua Zhao R, Batista O. et al. Percutaneous postoperative intra-abdominal abscess drainage after elective colorectal surgery. Tech Coloproctol 2002; 6 (03) 159-164
    CrossrefPubMedGoogle Scholar
  • 8 Gee MS, Kim JY, Gervais DA, Hahn PF, Mueller PR. Management of abdominal and pelvic abscesses that persist despite satisfactory percutaneous drainage catheter placement. AJR Am J Roentgenol 2010; 194 (03) 815-820
    CrossrefPubMedGoogle Scholar
  • 9 Akıncı D, Ergun O, Topel Ç, Çiftçi T, Akhan O. Pelvic abscess drainage: outcome with factors affecting the clinical success. Diagn Interv Radiol 2018; 24 (03) 146-152
    CrossrefPubMedGoogle Scholar
  • 10 Thomas MS, Margolin DA. Management of Colorectal Anastomotic Leak. Clin Colon Rectal Surg 2016; 29 (02) 138-144
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 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 (05) 586-592
    CrossrefPubMedGoogle Scholar
  • 12 Thorson AG, Thompson JS. Transrectal drainage of anastomotic leaks following low colonic anastomosis. Dis Colon Rectum 1984; 27 (07) 492-494
    CrossrefPubMedGoogle Scholar
  • 13 Alves A, Panis Y, Pocard M, Regimbeau JM, Valleur P. Management of anastomotic leakage after nondiverted large bowel resection. J Am Coll Surg 1999; 189 (06) 554-559
    CrossrefPubMedGoogle Scholar
  • 14 Parc Y, Frileux P, Schmitt G, Dehni N, Ollivier JM, Parc R. Management of postoperative peritonitis after anterior resection: experience from a referral intensive care unit. Dis Colon Rectum 2000; 43 (05) 579-587 , discussion 587–589
    CrossrefPubMedGoogle Scholar
  • 15 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 (06) 1147-1156
    CrossrefPubMedGoogle Scholar
  • 16 Parr MJ, Alabdi T. Damage control surgery and intensive care. Injury 2004; 35 (07) 713-722
    PubMedGoogle Scholar
  • 17 Blumetti J, Abcarian H. Management of low colorectal anastomotic leak: Preserving the anastomosis. World J Gastrointest Surg 2015; 7 (12) 378-383
    CrossrefPubMedGoogle Scholar
  • 18 Tartaglia D, Costa G, Camillò A. et al. Damage control surgery for perforated diverticulitis with diffuse peritonitis: saves lives and reduces ostomy. World J Emerg Surg 2019; 14: 19
    CrossrefPubMedGoogle Scholar
  • 19 Stafford C, Francone TD, Marcello PW, Roberts PL, Ricciardi R. Is diversion with ileostomy non-inferior to Hartmann resection for left-sided colorectal anastomotic leak?. J Gastrointest Surg 2018; 22 (03) 503-507
    CrossrefPubMedGoogle Scholar
  • 20 Hedrick TL, Sawyer RG, Foley EF, Friel CM. Anastomotic leak and the loop ileostomy: friend or foe?. Dis Colon Rectum 2006; 49 (08) 1167-1176
    CrossrefPubMedGoogle Scholar
  • 21 Klink CD, Lioupis K, Binnebösel M. et al. Diversion stoma after colorectal surgery: loop colostomy or ileostomy?. Int J Colorectal Dis 2011; 26 (04) 431-436
    CrossrefPubMedGoogle Scholar
  • 22 Tilney HS, Sains PS, Lovegrove RE, Reese GE, Heriot AG, Tekkis PP. Comparison of outcomes following ileostomy versus colostomy for defunctioning colorectal anastomoses. World J Surg 2007; 31 (05) 1142-1151
    CrossrefPubMedGoogle Scholar
  • 23 Güenaga KF, Lustosa SA, Saad SS, Saconato H, Matos D. Ileostomy or colostomy for temporary decompression of colorectal anastomosis. Cochrane Database Syst Rev 2007; (01) CD004647
    PubMedGoogle Scholar
  • 24 Messaris E, Sehgal R, Deiling S. et al. Dehydration is the most common indication for readmission after diverting ileostomy creation. Dis Colon Rectum 2012; 55 (02) 175-180
    CrossrefPubMedGoogle Scholar
  • 25 Gavriilidis P, Azoulay D, Taflampas P. Loop transverse colostomy versus loop ileostomy for defunctioning of colorectal anastomosis: a systematic review, updated conventional meta-analysis, and cumulative meta-analysis. Surg Today 2019; 49 (02) 108-117
    CrossrefPubMedGoogle Scholar
  • 26 Joh YG, Kim SH, Hahn KY, Stulberg J, Chung CS, Lee DK. Anastomotic leakage after laparoscopic protectomy can be managed by a minimally invasive approach. Dis Colon Rectum 2009; 52 (01) 91-96
    CrossrefPubMedGoogle Scholar
  • 27 Lee CM, Huh JW, Yun SH. et al. Laparoscopic versus open reintervention for anastomotic leakage following minimally invasive colorectal surgery. Surg Endosc 2015; 29 (04) 931-936
    CrossrefPubMedGoogle Scholar
  • 28 Krarup PM, Jorgensen LN, Harling H. Danish Colorectal Cancer Group. Management of anastomotic leakage in a nationwide cohort of colonic cancer patients. J Am Coll Surg 2014; 218 (05) 940-949
    CrossrefPubMedGoogle Scholar
  • 29 Chua CL. Surgical considerations in the Hartmann's procedure. Aust N Z J Surg 1996; 66 (10) 676-679
    CrossrefPubMedGoogle Scholar
  • 30 Horesh N, Rudnicki Y, Dreznik Y. et al. Reversal of Hartmann's procedure: still a complicated operation. Tech Coloproctol 2018; 22 (02) 81-87
    CrossrefPubMedGoogle Scholar
  • 31 Abbas MA. Endoscopic management of acute colorectal anastomotic complications with temporary stent. JSLS 2009; 13 (03) 420-424
    PubMedGoogle Scholar
  • 32 Lamazza A, Fiori E, De Masi E, Scoglio D, Sterpetti AV, Lezoche E. Self-expanding metal stents for treatment of anastomotic complications after colorectal resection. Endoscopy 2013; 45 (06) 493-495
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Lamazza A, Fiori E, Schillaci A, Sterpetti AV, Lezoche E. Treatment of anastomotic stenosis and leakage after colorectal resection for cancer with self-expandable metal stents. Am J Surg 2014; 208 (03) 465-469
    CrossrefPubMedGoogle Scholar
  • 34 DiMaio CJ, Dorfman MP, Gardner GJ. et al. Covered esophageal self-expandable metal stents in the nonoperative management of postoperative colorectal anastomotic leaks. Gastrointest Endosc 2012; 76 (02) 431-435
    CrossrefPubMedGoogle Scholar
  • 35 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 (04) 342-345
    CrossrefPubMedGoogle Scholar
  • 36 Weidenhagen R, Gruetzner KU, Wiecken T, Spelsberg F, Jauch KW. Endoscopic vacuum-assisted closure of anastomotic leakage following anterior resection of the rectum: a new method. Surg Endosc 2008; 22 (08) 1818-1825
    CrossrefPubMedGoogle Scholar
  • 37 Shalaby M, Emile S, Elfeki H, Sakr A, Wexner SD, Sileri P. Systematic review of endoluminal vacuum-assisted therapy as salvage treatment for rectal anastomotic leakage. BJS Open 2018; 3 (02) 153-160
    CrossrefPubMedGoogle Scholar
  • 38 Popivanov GI, Mutafchiyski VM, Cirocchi R. et al. Endoluminal negative pressure therapy in colorectal anastomotic leaks. Colorectal Dis 2020; 22 (03) 243-253
    CrossrefPubMedGoogle Scholar
  • 39 Mennigen R, Senninger N, Laukoetter MG. Novel treatment options for perforations of the upper gastrointestinal tract: endoscopic vacuum therapy and over-the-scope clips. World J Gastroenterol 2014; 20 (24) 7767-7776
    CrossrefPubMedGoogle Scholar
  • 40 Mizrahi I, Eltawil R, Haim N. et al. The clinical utility of over-the-scope clip for the treatment of gastrointestinal defects. J Gastrointest Surg 2016; 20 (12) 1942-1949
    CrossrefPubMedGoogle Scholar
  • 41 Sulz MC, Bertolini R, Frei R, Semadeni GM, Borovicka J, Meyenberger C. Multipurpose use of the over-the-scope-clip system (“Bear claw”) in the gastrointestinal tract: Swiss experience in a tertiary center. World J Gastroenterol 2014; 20 (43) 16287-16292
    CrossrefPubMedGoogle Scholar
  • 42 Weiland T, Fehlker M, Gottwald T, Schurr MO. Performance of the OTSC System in the endoscopic closure of iatrogenic gastrointestinal perforations: a systematic review. Surg Endosc 2013; 27 (07) 2258-2274
    CrossrefPubMedGoogle Scholar
  • 43 Brunner W, Rossetti A, Vines LC, Kalak N, Bischofberger SA. Anastomotic leakage after laparoscopic single-port sigmoid resection: combined transanal and transabdominal minimal invasive management. Surg Endosc 2015; 29 (12) 3803-3805
    CrossrefPubMedGoogle Scholar