The Colorectal Anastomosis: A Timeless Challenge

Abstract

Colorectal anastomosis is a sophisticated problem that demands an elaborate discussion and an elegant solution.“Those who forget the past are condemned to repeat it.”George Santayana, Life of Reason, 1905

Epiploic steal: is this concept the key to reducing colorectal anastomotic leak rates?

“…The colorectal anastomosis has been described as the “apotheosis” of its specialty, with literature that suggests it is most successfully done in specialised hands. Anastomotic leaks have devastating septic sequela and are potentially lethal if not detected, in addition to increasing local recurrence when performed for neoplastic pathology [ 1 ].…”

“…If high ligation of the IMA is performed, as commonly occurs in the setting of lymph node harvest in malignant disease, the distal descending colon relies on the additional supply rather than the natural left colic artery. Customary methods of assessing bowel viability (colour, bleeding, palpable pulses, or temperature) are subjective and not supported by a reliable evidence base [ 1 , 2 ].…”