Abstract
Background
Anastomotic leak is a dreaded surgical complication that can lead to significant morbidity and mortality. Despite its prevalence, there is no consensus on the management of anastomotic leak. This study aimed to review the management of anastomotic leak in the Division of Colon and Rectal Surgery at two institutions.
Methods
This is a retrospective review of all anastomotic leaks occurring after surgery in the Division of Colon and Rectal Surgery at two teaching institutions during 1997–2008.
Results
Altogether, 103 leaks occurred in 1,707 anastomoses (6 %), with a median time to diagnosis of 20 days (2–1,400 days). The 90-day mortality rate was 3 %. The majority of cases were managed nonoperatively (73 %), and the majority of leaks were from an extraperitoneal anastomosis (67 %). Success (i.e., radiographic demonstration of a healed leak, restored gastrointestinal continuity) occurred in 54 % of operatively managed leaks and 57 % of nonoperatively managed leaks (56 % overall). Operative management differed by leak location. In 91 % of patients with intraperitoneal leaks, the anastomosis was resected. In 76 % of patients with extraperitoneal leaks, diversion and drainage alone was performed without manipulating the anastomosis. Nonoperative management was successful for 57 % of extraperitoneal leaks and 58 % of intraperitoneal leaks. There was no significant difference in the success rates based on type of management (operative/nonoperative) for either extraperitoneal or intraperitoneal leaks.
Conclusions
Anastomotic leak continues to result in patient morbidity and mortality. Its diverse presentation requires tailoring management to the patient. Nonoperative and operative treatments are viable options for intraperitoneal and extraperitoneal leaks based on patient presentation.
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References
Rullier E, Laurent C, Garrelon JL et al (1998) Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 85:355–358
Kanellos I, Vasiliadis K, Angelopoulos S et al (2004) Anastomotic leakage following anterior resection for rectal cancer. Tech Coloproctol 8(Suppl 1):s79–s81
Vignali A, Fazio VW, Lavery IC et al (1997) Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1,014 patients. J Am Coll Surg 185:105–113
Buchs NC, Gervaz P, Secic M et al (2008) Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study. Int J Colorectal Dis 23:265–270
Wong NY, Eu KW (2005) A defunctioning ileostomy does not prevent clinical anastomotic leak after a low anterior resection: a prospective, comparative study. Dis Colon Rectum 48:2076–2079
Yeh CY, Changchien CR, Wang JY et al (2005) Pelvic drainage and other risk factors for leakage after elective anterior resection in rectal cancer patients: a prospective study of 978 patients. Ann Surg 241:9–13
Rose J, Schneider C, Yildirim C et al (2004) Complications in laparoscopic colorectal surgery: results of a multicentre trial. Tech Coloproctol 8(Suppl 1):s25–s28
Veyrie N, Ata T, Muscari F et al (2004) Anastomotic leakage after elective right versus left colectomy for cancer: prevalence and independent risk factors. J Am Coll Surg 205:785–793
Byrn JC, Schlager A, Divino CM et al (2006) The management of 38 anastomotic leaks after 1,684 intestinal resections. Dis Colon Rectum 49:1346–1353
Hyman N, Manchester TL, Osler T et al (2007) Anastomotic leaks after intestinal anastomosis: it’s later than you think. Ann Surg 245:254–258
Matthiessen P, Hallbook O, Andersson M et al (2004) Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis 6:462–469
Soeters PB, de Zoete JP, Dejong CH et al (2002) Colorectal surgery and anastomotic leakage. Dig Surg 19:150–155
Hedrick TL, Sawyer RG, Foley EF et al (2006) Anastomotic leak and the loop ileostomy: friend or foe? Dis Colon Rectum 49:1167–1176
Bruce J, Krukowski ZH, Al-Khairy G et al (2001) Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg 88:1157–1168
Phitayakorn R, Delaney CP, Reynolds HL et al (2008) Standardized algorithms for management of anastomotic leaks and related abdominal and pelvic abscesses after colorectal surgery. World J Surg 32:1147–1156. doi:10.1007/s00268-008-9468-1
Parc Y, Frileux P, Schmitt G et al (2000) Management of postoperative peritonitis after anterior resection: experience from a referral intensive care unit. Dis Colon Rectum 43:579–587
Lindgren R, Hallbook O, Rutegard J et al (2011) What is the risk for a permanent stoma after low anterior resection of the rectum for cancer? A six-year follow-up of a multicenter trial. Dis Colon Rectum 54:41–47
Khan AA, Wheeler JM, Cunningham C et al (2008) The management and outcome of anastomotic leaks in colorectal surgery. Colorectal Dis 10:587–592
Joh YG, Kim SH, Hahn KY et al (2009) Anastomotic leakage after laparoscopic protectomy can be managed by a minimally invasive approach. Dis Colon Rectum 52:91–96
Thornton M, Joshi H, Vimalachandran C et al (2011) Management and outcome of colorectal anastomotic leaks. Int J Colorectal Dis 26:313–320
Verlaan T, Bartels SA, van Berge Henegouwen MI (2011) Early, minimally invasive closure of anastomotic leaks: a new concept. Colorectal Dis 13(Suppl):718–722
Chopra SS, Mrak K, Hunerbein M (2009) The effect of endoscopic treatment on healing of anastomotic leaks after anterior resection of rectal cancer. Surgery 145:182–188
Matthiessen P, Hallbook O, Rutegard J et al (2007) Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg 246:207–214
Telem DA, Sur M, Tabrizian P et al (2010) Diagnosis of gastrointestinal anastomotic dehiscence after hospital discharge: impact on patient management and outcome. Surgery 147:127–133
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This manuscript was a Poster Presentation at the American Society of Colon and Rectal Surgeons annual meeting, Hollywood, FL, May 2009.
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Blumetti, J., Chaudhry, V., Cintron, J.R. et al. Management of Anastomotic Leak: Lessons Learned from a Large Colon and Rectal Surgery Training Program. World J Surg 38, 985–991 (2014). https://doi.org/10.1007/s00268-013-2340-y
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DOI: https://doi.org/10.1007/s00268-013-2340-y