Reoperation for Anastomotic Failure

ABSTRACT

Anastomotic leak is a dreaded complication of colorectal surgery, with many potential causes. This complication carries with it a reported mortality ranging from 6 to 39%. Early diagnosis is key for the prevention of mortality. Here, we discuss the causes of an anastomotic leak and its signs and symptoms. Moreover, we explore the various modalities of diagnosis and treatment options. Most important, we discuss when a patient needs to be taken to the operating room and what procedure should be performed given various intraoperative findings.

Anastomotic leak - anastomosis - anastomotic leak review

REFERENCES

• 1 Longo W E, Northover J. Reoperative Colon and Rectal Surgery. London, UK; Martin Dunitz, Taylor and Francis Group 2003
• 2 Vignali A, Gianotti L, Braga M et al.. Altered microperfusion at the rectal stump is predictive for rectal anastomotic leak.  Dis Colon Rectum. 2000;  43 76-82
• 3 Mileski W J, Joehl R J, Rege R V et al.. Treatment of anastomotic leakage following low anterior colon resection.  Arch Surg. 1988;  123 968-970
• 4 Rullier E, Laurent C, Garrelon L et al.. Risk factors for anastomotic leakage after resection of rectal cancer.  Br J Surg. 1998;  85 355-358
• 5 Enker W E, Merchant N, Cohen A M et al.. Safety and efficacy of low anterior resection for rectal cancer: 681 consecutive cases from a specialty service.  Ann Surg. 1999;  230 544-552
• 6 Golub R, Goulb R W, Cantu Jr R et al.. A multivariate analysis of factors contributing to leakage of intestinal anastomosis.  J Am Coll Surg. 1997;  184 364-372
• 7 Karanjia N D, Corder A P, Holdsworth P J et al.. Risk of peritonitis and fatal septicemia and the need to defunction the low anastomosis.  Br J Surg. 1991;  78 196-198
• 8 Beard J D, Micholson M L, Sayers R D et al.. Intraoperative air testing of colorectal anastomosis: a prospective, randomized trial.  Br J Surg. 1990;  77 1095-1097
• 9 Beck D E. Intraoperative anastomotic complications. In Hicks TC, Beck DE, Timmcke AE, Opelka FG Complications of Colon and Rectal Surgery. Baltimore; Williams & Wilkins 1996: 70-81
• 10 Sweeney W B. Intra-abdominal anastomotic techniques.  Clin Colon Rectal Surg. 2001;  14 15-24
• 11 MacRae H M, McLeod R S. Handsewn vs. stapled anastomosis in colon and rectal surgery: a meta-analysis.  Dis Colon Rectum. 1998;  41 180-189
• 12 Fingerhut A, Hay J M, Elhadad A et al.. Supraperitoneal colorectal anastomosis: hand sewn versus circular stapler-a controlled clinical trial.  Surgery. 1995;  118 479-485
• 13 Vignali A, Fazio V W, Lavery I C et al.. Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1,014 patients.  J Am Coll Surg. 1997;  185 105-113
• 14 Hilsabeck J R. The presacral space as a collector of fluid accumulations following rectal anastomosis: tolerance of rectal anastomosis to closed suction drainage.  Dis Colon Rectum. 1982;  25 680-684
• 15 Urbach D R, Kennedy E D, Cohen M M et al.. Colon and rectal anastomosis do not require routine drainage: a systematic review and meta-analysis.  Ann Surg. 1999;  229 174-180
• 16 Tocchi A, Mazzoni G, Lepre L et al.. Prospective evaluation of omentoplasty in preventing leakage of colorectal anastomosis.  Dis Colon Rectum. 2000;  43 951-955
• 17 Agnifili A, Schietroma M, Carloni A et al.. The value of omentoplasty in protecting colorectal anastomosis from leakage. A prospective randomized study in 126 patients.  Hepatogastroenterology. 2004;  51 1694-1697
• 18 Merad F, Hay J M, Fingerhut A et al.. Omentoplasty in the prevention of anastomotic leakage after colonic or rectal resection: a prospective randomized study in 712 patients.  Ann Surg. 1998;  227 179-186
• 19 Matthiessen P, Hallböök O, Andersson M, Rutegård J, Sjödahl R. Risk factors for anastomotic leakage after anterior resection of the rectum.  Colorectal Dis. 2004;  6 462-469
• 20 Marusch F, Koch A, Schmidt U et al.. Value of a protective stoma in low anterior resections for rental cancer.  Dis Colon Rectum. 2002;  45 1164-1171
• 21 Kong A, Kumar R R, Stamos M J. Treatment of rectal cancer with single stage coloanal or ultralow colorectal anastomosis does not adversely affect morbidity and mortality.  , Int J Colorectal Dis. In press
• 22 Longo W E, Milsom J W, Lavery I C et al.. Pelvic abscess after colon and rectal surgery-what is optimal management?.  Dis Colon Rectum. 1993;  36 936-941
• 23 Makela J T, Kiviniemi H, Laitinen S. Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis.  Dis Colon Rectum. 2003;  46 653-660
• 24 Nesbakken A, Nygaard K, Lunde O C. Outcome and late functional results after anastomotic leakage following mesorectal excision for rectal cancer.  Br J Surg. 2001;  88 400-404
• 25 Law W L, Chu K W. Anterior resection for rectal cancer with mesorectal excision.  Ann Surg. 2004;  240 260-268
• 26 Marusch F, Koch A, Schmidt U et al.. Value of a protective stoma in low anterior resections for rectal cancer.  Dis Colon Rectum. 2002;  45 1164-1171