Reducing anastomotic leak in colorectal surgery: The old dogmas and the new challenges

Abstract

Anastomotic leak (AL) constitutes a significant issue in colorectal surgery, and its incidence has remained stable over the last years. The use of intra-abdominal drain or the use of mechanical bowel preparation alone have been proven to be useless in preventing AL and should be abandoned. The role or oral antibiotics preparation regimens should be clarified and compared to other routes of administration, such as the intravenous route or enema. In parallel, preoperative antibiotherapy should aim at targeting collagenase-inducing pathogens, as identified by the microbiome analysis. AL can be further reduced by fluorescence angiography, which leads to significant intraoperative changes in surgical strategies. Implementation of fluorescence angiography should be encouraged. Progress made in AL comprehension and prevention might probably allow reducing the rate of diverting stoma and conduct to a revision of its indications.

Influence of combined mechanical-chemical versus mechanical bowel preparation on anastomotic leak and surgical site infections after elective resection of left colon cancer

“…20 Similar results were recently reported in the setting of open or even minimally invasive colon resections. 13,21,22 We have also found decreased rates of infectious complications, including wound infections and intraabdominal abscesses, and ileus among patients in MBP and OABx. These observations are in agreement with Kiran and coworkers who demonstrated that preoperative antibiotics in combination with mechanical bowel preparation resulted in almost 50% reduction in postoperative infectious complications and ileaus.…”

“…12 In this context, MBP is supposed to enhance the uptake of OABx by colonic mucosa. 13 This concept was supported by the documented advantage of oral over intravenous antibiotics when administered after MBP as preparatory measure before colon and rectal resections. 14 Thus, the mitigation of AL and SSI rates in patients who received MBP prior to elective left colectomy could be attributed to the synergistic effect induced by combining MBP and OABx.…”

“…14 Thus, the mitigation of AL and SSI rates in patients who received MBP prior to elective left colectomy could be attributed to the synergistic effect induced by combining MBP and OABx. 13 Therefore, in this study we will address, for the first time from South Egypt cancer surgery programs, the influence of dual bowel preparation (MBP and OABx) versus MBP alone before elective resection of left colon cancer on the incidence of AL, SSI and overall complications.…”

Anastomotic Leakage Following Colorectal Cancer Surgery: Comparison Between Conservative and Surgical Treatment

“…Previous studies indicated a rate of AL of 4%-29 %, [11][12][13][14] and several risk factors for AL after colorectal cancer surgery have been discussed [20][21][22], as well as methods to reduce the rate, prevent AL, and the related risk factors [23][24][25][26].…”

"End-to-end" and "end-to-side” colorectal anastomosis: does the selection of surgical tactics influence insufficiency of the apparatus anastomosis?

“…У больных группы 2 встречались единичные осложнения (частичная несостоятельность анастомоза класса В -у 2 (14,3%) больных, серома послеоперационной раны -у 2 (14,3%) больных, тогда как частичной несостоятельности анастомоза класса С, перитонита или лимфореи не наблюдалось. Количество дней от операции до выписки у больных группы 2 было меньшим и составило 9 [7][8][9][10][11][12][13] дней по сравнению с 13,0 [9-20] днями у больных группы 1. У больных раком прямой кишки после передней резекции прямой кишки выбор хирургической тактики наложения аппаратных колоректальных анастомозом «конец-в-конец» и «конец-в-бок» влияет на частоту развития несостоятельности анастомозов; наложение анастомозов «конец-в-бок» уменьшает частоту и тяжесть несостоятельности колоректальных анастомозов, что способствует сокращению послеоперационного восстановительного периода.…”