Ewha Med J.  2023 Dec;46(S1):e29. 10.12771/emj.2023.e29.

Preventing Anastomotic Leakage, a Devastating Complication of Colorectal Surgery

• Lee HG

• KMID: 2550849
• DOI: http://doi.org/10.12771/emj.2023.e29

Abstract

Anastomotic leakage (AL) after colorectal surgery is a significant concern, as it can lead to adverse functional and oncologic outcomes. Numerous studies have been conducted with the aim of identifying risk factors for AL and developing strategies to prevent its occurrence, thereby reducing the severe morbidity associated with AL. The intraoperative method for reducing AL includes a mechanical assessment of AL, an assessment of bowel perfusion, drain placement, and the creation of diverting stomas. The anastomosis technique is also associated with AL, and the appropriate selection and accurate application of anastomotic methods are crucial for preventing AL. Indocyanine green fluorescence imaging has recently gained popularity as a method for assessing bowel perfusion. While it is useful for detecting bowel perfusion, standardized protocols and measurement methods need to be established to ensure its reliability and effectiveness in clinical practice. The use of intraoperative drains to reduce AL has produced inconsistent results, and the routine adoption of this practice is not currently recommended. Diverting stomas can be used to help reduce the morbidity associated with AL. However, it is important to carefully consider the complications that can arise directly from the stoma itself. It should be noted that while a stoma can reduce AL, it cannot completely prevent it. This descriptive review examines various intraoperative methods aimed at reducing AL, discussing their effectiveness in reducing AL.

Keyword

Anastomotic leakage; Colorectal surgery; Indocyanine green

Figure

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  Fig. 1. Intracorporeal circular reinforcing sutures around a colorectal anastomosis following robotic low anterior resection. A continuous suture was done, including the linear-cut surface of rectal transection and circular anastomosis with a barbed suture. Unpublished photos of Sung Soo Yang with permission.

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  Fig. 2. Modified reverse air-leak test. (A) An air bubble is assessed within the rectum using circular anal dilator after filling the rectum with water. (B) A reinforcing suture is applied. (C) The absence of an air-leak is confirmed. Adapted from Crafa et al. [35] with CC-BY.

Reference

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