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. 2022 Apr;92(4):801-805.
doi: 10.1111/ans.17450. Epub 2022 Jan 6.

The management of asymptomatic radiological anastomotic leakage following anterior resection

Mohamed Rabie  1   2 , Laura Parry  1 , Iannish Sadien  1 , Sandeep Kapur  1 , Adam Stearns  1   3 , Irshad Shaikh  1   3
Affiliations

The management of asymptomatic radiological anastomotic leakage following anterior resection

Mohamed Rabie et al. ANZ J Surg. 2022 Apr.

Abstract

Background: The evidence to guide the management of asymptomatic radiologically-detected anastomotic leakages (ARAL) following anterior resection (AR) with diverting ileostomy is deficient. This study describes the outcomes of managing ARAL one of the UK teaching hospitals.

Method: The study included all patients diagnosed with ARAL following AR during 8 years period (2012-2020). The following data were retrospectively collected: patient demographics, surgical indication, anastomotic technique, tumour staging, neoadjuvant therapy, how ARAL was managed, the outcomes and duration to heal and ileostomy reversal.

Results: A total of 35 patients (M = 24) who developed ARAL during the study period were included. In 32 patients, AR was performed for rectal cancer. All patients with ARAL were treated conservatively and in 31 (89%) patients, there was complete resolution of the leakage within a median duration of 6 months. Covering loop ileostomies were reversed in 26 (74%) patients with a median interval to reversal of 10 months.

Conclusion: Most asymptomatic radiologically-detected anastomotic leakages after anterior resection heal with conservative treatment in the presence of a covering loop ileostomy with an expected average delay of 6 months for the leakage to heal before covering ileostomies can be reversed.

Keywords: anastomosis; anterior resection; asymptomatic leakage; conservative treatment; ileostomy; rectal cancer.

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