How to Prevent Anastomotic Leak in Colorectal Surgery? A Systematic Review

Abstract

Anastomosis leakage (AL) after colorectal surgery is an embarrassing problem. It is associated with poor consequence. This review aims to summarize published evidence on prevention of AL after colorectal surgery and provide recommendations according to the Oxford Centre for Evidence-Based Medicine. We conducted bibliographic research on January 15, 2020, of PubMed, Cochrane Library, Embase, Scopus, and Google Scholar. We retained meta-analysis, reviews, and randomized clinical trials. We concluded that mechanical bowel preparation did not reduce AL. It seems that oral antibiotic or oral antibiotic with mechanical bowel preparation could reduce the risk of AL. The surgical approach did not affect the AL rate. The low ligation of the inferior mesenteric artery could reduce the AL rate. The mechanical anastomosis is superior to handsewn anastomosis only in case of right colectomies, with similar results in rectal surgery between the 2 anastomosis techniques. In the case of right colectomies, this anastomosis could be performed intracorporeally or extracorporeally with similar outcomes. The air leak test did not reduce AL. There is no interest of external drainage in colonic surgery but drains reduced the rate of AL and rate of reoperation after low anterior resection. The transanal tube reduced the rate of AL.

Surgical safety in the COVID-19 era: present and future considerations

“…Postoperative COVID-19 infection was significantly associated with mortality (adjusted odds ratio, 16.90; P < 0.001), which required surgeons to undertake stringent mitigation measures [ 27 ]. Furthermore, the leakage rate presented in this study was comparable to those of around 10% reported in the pre-pandemic era [ 37 38 ]. In addition, a further study reported a 10-fold increase in mortality among symptomatic COVID-19 patients but only a 2-fold increase in asymptomatic patients after gastrointestinal surgery.…”

Regional techniques for pain management following laparoscopic elective colonic resection: A systematic review

“…The amount of opioid consumption was similar between the two groups (37.5 ± 28.4 mg versus 40.2 ± 25 mg, P = 0.15), and the mean VAS scores did not differ at any time at rest and effort. Concerning the postoperative rehabilitation, there was no difference between the groups: incidence of vomiting and nausea (p = 0.58), length of hospital stay (4 [ [3] , [4] , [5] ] versus 4 [ 4 , 5 ], P = 0.73) and time to recovery of intestinal function.…”

“…Total morphine consumption was 12 mg in the WIG arm versus 9 mg. There was no significant difference in hospital stay length with a median of 4 [ [3] , [4] , [5] ] days and postoperative complications.…”

“…Kaba et al [ 21 ], in a RCT (level 1b), compared 20 patients (lidocaine IV group) to 20 patients (placebo group). They showed that lidocaine infusion improved postoperative analgesia (opioid consumption and VAS scores were shorter in the lidocaine group) in addition to facilitated acute postoperative recovery by reducing the length of hospital stay (2 [ 2 , 3 ] versus 3 [ 3 , 4 ], P = 0.001) and improving the return of bowel function. The other two RCTs (level 1b) confirmed lidocaine IV infusion's superiority in pain management and postoperative recovery compared to placebo [ 19 , 20 ].…”

“…Colorectal surgery is one of the most common surgical operations worldwide due essentially to an increasing incidence of colonic and rectal tumors [ 1 ]. It is also related to a high rate of morbidity, which ranges from 24.6 to 48.3% [ 2 , 3 ]. Therefore, in 2005, The Enhanced Recovery After Surgery (ERAS) Society proposed a new concept to reduce perioperative stress, maintain the postoperative physiological function, and accelerate recovery after surgery to shorten hospital stay length [ 4 ].…”