Can intraluminal devices prevent or reduce colorectal anastomotic leakage: a review

Abstract

Colorectal anastomotic leakage is a serious complication of colorectal surgery, leading to high morbidity and mortality rates. In recent decades, many strategies aimed at lowering the incidence of anastomotic leakage have been examined. The focus of this review will be on mechanical aids protecting the colonic anastomosis against leakage. A literature search was performed using MEDLINE, EMBASE, and The Cochrane Collaborative library for all papers related to prevention of anastomotic leakage by placement of a device in the colon. Devices were categorised as decompression devices, intracolonic devices, and biodegradable devices. A decompression device functions by keeping the anal sphincter open, thereby lowering the intraluminal pressure and lowering the pressure on the anastomosis. Intracolonic devices do not prevent the formation of dehiscence. However, they prevent the faecal load from contacting the anastomotic site, thereby preventing leakage of faeces into the peritoneal cavity. Many attempts have been made to find a device that decreases the incidence of AL; however, to date, none of the devices have been widely accepted.

Keywords: Anastomotic leakage; Colorectal surgery; Complication; Device; Rectum.

Figure 1

Transanal stent.

Figure 2

The Coloshield. A: The coloshield is sutured to the submucosa of the bowel proximal of the anastomosis; B and C: Slight traction is placed on the coloshield and it is cut so that it lies in the rectal ampulla.

Figure 3

Polyflex stents with a proximal flare.

Figure 4

Murphy’s button. John Benjamin Murphy developed his device in 1892 as a quick and safe method of intestinal anastomosis. The steel Murphy button had two rounded heads mounted on hollow shafts. After the intestinal ends were tied on the shafts, the heads were screwed together to compress the tissue.

Figure 5

Valtrac-secured intracolonic bypass device. A: Rough colorectal anastomosis with large gaps between sutures protected by the intracolonic bypass; B: Biofragmentable anastomosis ring.

Figure 6

C-seal: A biodegradable drain protecting the anastomosis.