Minimally invasive management of anastomotic leaks in colorectal surgery

Abstract

Anastomotic leakage is an unfortunate complication of colorectal surgery. This distressing situation can cause severe morbidity and significantly affects the patient’s quality of life. Additional interventions may cause further morbidity and mortality. Parenteral nutrition and temporary diverting ostomy are the standard treatments of anastomotic leaks. However, technological developments in minimally invasive treatment modalities for anastomotic dehiscence have caused them to be used widely. These modalities include laparoscopic repair, endoscopic self-expandable metallic stents, endoscopic clips, over the scope clips, endoanal repair and endoanal sponges. The review aimed to provide an overview of the current knowledge on the minimally invasive management of anastomotic leaks.

Endoscopic repair of anastomotic leakage after low anterior resection for rectal cancer: A systematic review

“…Indications for the use of OTSC is an anastomotic gap <15 mm without any luminal stenosis or abscesses. It can be applied both early or late after AL . Its success rate is reported to be overall 86%, 87% in acute and 83% in chronic conditions, while another study revealed a success rate of 92.7% .…”

“…Absolute contraindication for its application is the existence of visible vessels within the cavity and a relative one includes all cases of higher anastomoses. The need of repeated change of the sponge every 2‐4 days till closure causes patient discomfort and is a disadvantage of this method . VAC therapy seems to have a high success rate based on the results of several studies evaluating the efficacy of this method.…”

“…Eligible for analysis were 24 publications that referred to anastomotic leak after low anterior resection for rectal cancer and reported detailed information about patients' characteristics. Eight articles out of 24 were clinical studies, five were reviews, one systematic review and 10 were case reports and series, including 75 cases of endoscopic repair of anastomotic leak (Table ). These articles were carefully analyzed and a database with the patients' characteristics was made.…”

“…It can be applied both early or late after AL. 4,8,9,24 Its success rate is reported to be overall 86%, 87% in acute and 83% in chronic conditions, while another study revealed a success rate of 92.7%. 4 The additional use of endosponge therapy is required in some cases.…”

“…The need of repeated change of the sponge every 2-4 days till closure causes patient discomfort and is a disadvantage of this method. 4,8,9,24 VAC therapy seems to have a high success rate based on the results of several studies evaluating the efficacy of this method. Nerup et al reported a successful closure of AL in all patients participating in the study, while the stoma reversal rate was 97%.…”