Clinics in Colon and Rectal Surgery 2019; 32(03): 190-195
DOI: 10.1055/s-0038-1677025
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Operative Management of Anastomotic Leaks after Colorectal Surgery

Nicole M. Saur
1  Division of Colon and Rectal Surgery, Department of Surgery, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania
,
E. Carter Paulson
1  Division of Colon and Rectal Surgery, Department of Surgery, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania
2  Department of General Surgery, Corporal Michael J. Crescenze VA Medical Center, Philadelphia, Pennsylvania
› Author Affiliations
Further Information

Publication History

Publication Date:
02 April 2019 (eFirst)

Abstract

Anastomotic leak is associated with increased morbidity and mortality after colorectal surgery. Although surgical techniques have improved over time, anastomotic leak is still a reality in colorectal surgery with rates ranging from as low as 1% for low-risk anastomoses, such as enteroenteric or ileocolic, to 19% for high-risk coloanal anastomoses. There are many varied risk factors for anastomotic leak. However, many of the risk factors have not been definitively proven in high-quality studies. Presumably, risk factors are cumulative and every effort should be made to optimize modifiable risk factors in the perioperative period. Treatment of anastomotic leak should start with the determination of patient stability followed by resuscitation and diagnostic imaging or operative exploration. Operative findings will dictate surgical approach with the goal of controlling sepsis and stabilizing the patient. If nonoperative treatment is undertaken, close patient monitoring is necessary to ensure control of sepsis and that intervention is undertaken if the clinical picture changes. Early intervention at each stage is key to decreasing the morbidity of anastomotic leak.