Colorectal anastomotic leakage: aspects of prevention, detection and treatment

Abstract

All colorectal surgeons are faced from time to time with anastomotic leakage after colorectal surgery. This complication has been studied extensively without a significant reduction of incidence over the last 30 years. New techniques of prevention, by innovative anastomotic techniques should improve results in the future, but standardization and "teachability" should be guaranteed. Risk scoring enables intra-operative decision-making whether to restore continuity or deviate. Early detection can lead to reduction in delay of diagnosis as long as a standard system is used. For treatment options, no firm evidence is available, but future studies could focus on repair and saving of the anastomosis on the one hand or anastomotical breakdown and definitive colostomy on the other hand.

Keywords: Anastomotic leakage; Colorectal surgery; Complications; Postoperative care; Prevention.

Figure 1

C-seal. Endoluminal biodegradable anastomotic cover. Printing with permission from Bakker et al[17].

Figure 2

The Dutch Leakage Score. According to the points attributed to the patients on the basis of clinical symptoms, treating doctors can follow this diagnostic flowchart. Reprinted from den Dulk et al[19]. CT: Computed tomography; AL: Anastomotic leak.