Early, minimally invasive closure of anastomotic leaks: a new concept

Verlaan, Tessa; Bartels, Sanne A L; Henegouwen, Mark I. van Berge; Tanis, Pieter J.; Fockens, Paul; Bemelman, Willem A.

doi:10.1111/j.1463-1318.2011.02775.x

Cited by 58 publications

(60 citation statements)

References 11 publications

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“…In conclusion, patients with rectal cancer and TaTME are at increased risk for AL after sphincter‐preserving TME, especially after neoadjuvant chemoradiation. The improvement in techniques and patient expectation of avoiding a long‐term stoma mean that standardized concepts for effective management of AL after TaTME need to be validated . Our study demonstrates the possibility of anastomosis‐preserving treatment in the case of AL according to a damage control strategy.…”

Section: Discussionmentioning

confidence: 99%

Anastomotic leak after transanal total mesorectal excision: grading of severity and management aimed at preservation of the anastomosis

et al. 2019

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Aim The transanal approach to total mesorectal excision (TaTME) as an alternative to conventional anterior resection offers an improved view to otherwise restricted anatomical regions in obese and narrow male pelves and unfavourable tumour locations. Guidelines for the management of anastomotic leakage (AL) following low rectal resections are scarce. Patients and methods Prospectively collected data of all consecutive patients undergoing TaTME between December 2014 and April 2017 in our centre were analysed retrospectively. Existing classification systems for AL were modified with regard to transanal anastomotic‐preserving management. Results TaTME was performed in 66 patients with a median age of 56.2 years. The overall incidence of AL was 12.1% (n = 8). AL grading was differentiated in Grades I to V according to the severity of necrosis and abscess development. Two patients suffered from AL Grade II, one patient from Grade III, three patients from Grade IV and two patients from Grade V. Preservation of the anastomosis following AL was achieved by the damage control concept in six of eight patients (75%) with a median duration of hospital stay of 36 days. Two patients received a Hartmann procedure (Grades IV and V). Conclusion Our study demonstrates that management of AL following TaTME is challenging but definitely amenable to strategies aimed at preserving the anastomosis by appropriate damage control. The modified classification system might serve as guidance for anastomosis‐preserving management.

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Section: Discussionmentioning

confidence: 99%

Anastomotic leak after transanal total mesorectal excision: grading of severity and management aimed at preservation of the anastomosis

et al. 2019

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“…It leads to increased morbidity (extended hospital stay, re-operation, permanent enterostomy and higher recurrence rates for carcinoma) and even up to 7% mortality [3,4]. Many studies describe risk factors for CAL [5,6], several studies describe prevention methods [7,8], and some describe diagnostic procedures for early detection [9,10,11,12], but only a few studies have described treatment options for CAL [13,14,15]. In treating patients with anastomotic leakage, many factors should be considered before engaging a therapeutic strategy, such as patient age, co-morbidities, level of anastomosis, delay after primary operation, presence of abdominal sepsis, degree of anastomotic dehiscence.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Colorectal Anastomotic Leakage: Results of a Questionnaire amongst Members of the Dutch Society of Gastrointestinal Surgery

et al. 2012

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Anastomotic leakage after colorectal surgery is correlated with considerable morbidity and mortality. Although many studies focus on risk factors and detection, studies on the treatment strategy for colorectal anastomotic leakage are scarce. A national questionnaire amongst 350 members of the Dutch Society for Gastrointestinal Surgery was undertaken on the current treatment of colorectal anastomotic leakage. The response was 40% after two anonymous rounds. 27% of the respondents state that a leaking anastomosis above the level of the promontory should be salvaged in ASA 1-2 patients <80 years of age, for ASA 3 and/or >80 years of age this percentage is 7.3%. For an anastomosis under the promontory, 50% of the respondents choose preserving the anastomosis for ASA 1-2 compared to 17% for ASA 3 and/or >80 years of age. In ASA 1-2 patients with a local abscess after a rectum resection without protective ileostomy, 31% of the respondents will create an protective ileostomy, 40% break down the anastomosis to create a definite colostomy, in ASA 3 and/or >80 years of age 14% of the respondents create a protective ileostomy and 63% a definitive colostomy. In ASA 1-2 patients with peritonitis after a rectum resection with deviating ileostomy, 31% prefer a laparotomy for lavage and repair of the anastomosis, 25% for lavage without repair and 36% of the respondents prefer to break down the anastomosis. When the patient is ASA 3 and/or >80 years of age, 13% prefer repair, 9% a lavage and 74% breaking down the anastomosis. This questionnaire shows that in contrast to older people, more surgeons make an effort to preserve the anastomosis in younger people.

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“…Im Gegensatz hierzu ist zumindest theoretisch bei gut durchbluteten, wenig dehiszenten Leckagen von Kolonanastomosen auch das endoskopische Clipping mit einem «Over-the-Scope»-System möglich [16,54,55]. Allerdings sind bei Detektion von Anastomoseninsuffizienzen die Gewebeverhältnisse selten für die Anwendung von Clips geeignet.…”

Section: Therapie Bei Anastomoseninsuffizienzen Nach Kolorektaler Resunclassified

Nahtinsuffizienz intestinaler Anastomosen: Endoskopische und laparoskopische Therapieoptionen

Werner¹,

Sauer

2013

Visc Med

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Hintergrund: Anastomoseninsuffizienzen stellen die schwerwiegendste septische Komplikation nach viszeralchirurgischen Eingriffen dar. Neben der chirurgischen Therapie sind zunehmend endoskopische Behandlungsoptionen möglich. Methode: Literaturübersicht. Ergebnisse: Therapieoptionen von Anastomoseninsuffizienzen sind abhängig von der klinischen Symptomatik, der Art der Anastomose, der Defektgröße, den lokalen Gewebeverhältnissen sowie dem Zeitpunkt der Diagnose. Bei einer Nekrose oder Minderdurchblutung der Viszeralorgane müssen diese operativ reseziert werden. Prinzipiell sind alle operativen Revisionseingriffe auch laparoskopisch durchführbar. Bei erhaltener Gewebeperfusion können die Leckagen lokal übernäht oder endoskopisch verschlossen werden. Die Ergebnisse für die Stenttherapie nach Ösophagus- und Magenresektionen sind für moderne Stents sehr Erfolg versprechend. Im Gegensatz dazu sind die Ergebnisse der endoskopischen Stenttherapie bei Insuffizienz nach kolorektalen Eingriffen enttäuschend; dafür steht hier mit der Schwammtherapie eine vielversprechende endoskopische Alternative zur Verfügung. Schlussfolgerung: Die aktuellen Daten zeigen, dass neue laparoskopische und endoskopische Optionen zur Therapie von Anastomoseninsuffizienzen bestehen, die jedoch noch in prospektiven und randomisierten Studien evaluiert werden müssen.

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Early, minimally invasive closure of anastomotic leaks: a new concept

Cited by 58 publications

References 11 publications

Anastomotic leak after transanal total mesorectal excision: grading of severity and management aimed at preservation of the anastomosis

Anastomotic leak after transanal total mesorectal excision: grading of severity and management aimed at preservation of the anastomosis

Treatment of Colorectal Anastomotic Leakage: Results of a Questionnaire amongst Members of the Dutch Society of Gastrointestinal Surgery

Nahtinsuffizienz intestinaler Anastomosen: Endoskopische und laparoskopische Therapieoptionen

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