Postoperative leakage and abscess formation after colorectal surgery

Abstract

Anastomotic leaks following colorectal surgery may be divided into those which are clinically significant and those which are not. Leakage occurs in 3.4-6% of all colorectal cases. It is most commonly associated with rectal anastomoses, being clinically significant in 2.9-15.3% of cases. Mortality following a leak may be 6.0-39.3%. There is no evidence that preoperative bowel preparation reduces the rate and consequences of leaks. There is no evidence for the use of drains when an anastomosis has been made outside the pelvis, but pelvic drainage may be important after anterior resection. The use of covering stomas has not been shown to reduce leak rate but does mitigate the clinical effects of leaks. Prompt diagnosis and further laparotomy can reduce mortality following leakage. Intra-abdominal abscesses can in most cases be treated by radiologically guided drainage. Anastomotic leaks are the most common cause of anastomotic strictures and are also associated with increased rates of local recurrence of cancer.

The management and outcome of anastomotic leaks in colorectal surgery

“…Mileski et al [15] reported that the formation of end colostomy at re-operation in leaks following low anterior resections conferred a survival benefit over anastomotic repair with proximal defunctioning. Moreover, other long-term sequelae of anastomotic leaks include stricture formation, recurrence of cancer and poor anorectal function [16]. From our series, 75% of patients with a stoma formed at re-operation were reversed within a year following formation.…”

Treatment with corticosteroids and the risk of anastomotic leakage following lower gastrointestinal surgery: a literature survey

“…The single factor consistently shown to predict leakage is a low rectal anastomosis [3]. Much research has been carried out to determine additional risk factors for AL and those reported include radiotherapy, male sex [4,5], smoking [6], perioperative treatment with cyclooxygenase 2 (COX-2)-selective nonsteriodal anti-inflammatory drugs (NSAIDs) [7], blood transfusion, obesity, atherosclerosis [8] and inflammatory bowel disease [3]. Better understanding of the risk factors for AL will not only improve the management of high-risk patients but will also allow for preventive treatments, such as creating a protective stoma.…”

Transanal minimally invasive surgery as a treatment option for a completely occluded anastomosis after low anterior resection: A new approach to severe anastomotic stenosis

“…The use of diverting stomas has also been associated with stricture formation. Because feces in the lower rectum induce distention, the absence of feces may induce atrophy of the muscle cells with subsequent stenosis (3,6). Treatment for postoperative anastomotic stricture varies from conservative to surgical treatment.…”