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Review
. 2021 Oct 1;34(6):359-365.
doi: 10.1055/s-0041-1735265. eCollection 2021 Nov.

Defining Anastomotic Leak and the Clinical Relevance of Leaks

Clayton Tyler Ellis  1 , Justin A Maykel  2
Affiliations
Review

Defining Anastomotic Leak and the Clinical Relevance of Leaks

Clayton Tyler Ellis et al. Clin Colon Rectal Surg. .

Abstract

Surgeons universally dread gastrointestinal anastomotic leaks, yet the precise definition is not widely agreed on despite international consensus guidelines. Likewise, leaks are not uniformly reported which makes comparisons across studies flawed. Leak rates range from 1 to 3% for ileocolonic, 0.5 to 18% for colorectal, and 5 to 19% for coloanal anastomoses. The sequelae of an anastomotic leak vary but generally correlate with the need for a change in clinical management, from minimal changes to the need for reoperation. Short- and long-term outcomes can be life-altering or life-threatening. Temporary or permanent stomas may be necessary and low pelvic anastomotic leaks may affect bowel function. For cancer patients, leaks can delay treatment and negatively affect oncologic outcomes. In Crohn's patients, leaks are associated with higher recurrence rates. In essence, the lack of agreement on the definition of an anastomotic leak inhibits meaningful understand of its epidemiology, prevention, and treatment.

Keywords: anastomosis; colorectal; definition; leak; relevance.

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Conflict of interest statement

Conflict of Interest The authors have no relevant conflicts of interest to report.

Figures

Fig. 1
Fig. 1
Sagittal and coronal views of a colorectal anastomotic leak with extraluminal fluid and gas.
Fig. 2
Fig. 2
Rectal contrast enema with posterior colorectal anastomotic leak (arrow) after low anterior resection.
See this image and copyright information in PMC

References

    1. Bruce J, Krukowski Z H, Al-Khairy G, Russell E M, Park K G. Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg. 2001;88(09):1157–1168. - PubMed
    1. Rahbari N N, Weitz J, Hohenberger W. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery. 2010;147(03):339–351. - PubMed
    1. Eckmann C, Kujath P, Schiedeck T HK, Shekarriz H, Bruch H-P. Anastomotic leakage following low anterior resection: results of a standardized diagnostic and therapeutic approach. Int J Colorectal Dis. 2004;19(02):128–133. - PubMed
    1. McDermott F D, Heeney A, Kelly M E, Steele R J, Carlson G L, Winter D C. Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg. 2015;102(05):462–479. - PubMed
    1. Daniel V T, Alavi K, Davids J S. The utility of the delphi method in defining anastomotic leak following colorectal surgery. Am J Surg. 2020;219(01):75–79. - PubMed