Failure of Colorectal Anastomosis: Risk Factors, Prevention, Diagnosis, Therapeutic Tactics

Abstract

Aim. To analyse and generalize available literature data on the problem of colorectal anastomotic leakage after rectal resection. Key findings. Over the last decade, there has been an increasing trend towards sphincter-preserving operations in modern colorectal surgery. The widespread use of suturing devices of various diameters allows the formation of ultra-low anastomoses (at the level of the pelvic floor). One of the menacing complications after rectal resection is anastomotic leakage, which frequency can reach 21%. The mortality from anastomotic leakage can reach 40%. The analysed literature sources discuss a variety of risk factors, both preoperative and intraoperative, affecting the healing of the inter-intestinal anastomosis. In almost all studies, the height of the tumour and the anastomosis from the anus, preoperative radiotherapy and male sex are independent risk factors for the development of colorectal anastomotic leakage. Concerning other factors, there are conflicting opinions. The timely use of preventive measures and early diagnosis of colorectal anastomotic leakage can reduce the number and severity of postoperative complications.Conclusion. Individual consideration of risk factors and their adequate assessment in terms of possible complications are decisive in the choice of the extent of surgical intervention, which will undoubtedly improve the immediate and long-term results of the surgical treatment of colorectal cancer.

Preoperative Risk Factors for Anastomotic Leaks in Colorectal Surgery

“…There is strong evidence that preoperative radiotherapy for colorectal cancer increases the risk for anastomotic leakage. Neoadjuvant radiotherapy that's routinely used in many patients may cause tissue edema, loss of tissue planes, pelvic fibrosis, bowel obstruction, necrosis and anastomotic failure [1,26].…”

“…Advanced technology has allowed many of the most severe complications of intestinal surgery, to be detected early and often to be treated without surgical intervention. Anastomotic leakage (AL) is one of the most feared complications following any type of intestinal anastomosis due to increased risk of morbidity, mortality, overall impact on functional outcome and expenditure on hospital resources [1][2][3].…”

Laparoscopic and Robotic-Assisted Surgeryfor Complicated Diverticu

“…Patients with complicated diverticulitis often require sigmoid resection down to the rectosigmoid junction to avoid diverticulitis relapses and complications. However, potential risks of bowel resection are mainly those of any major complications including anastomotic leakage (AL), which is the most common cause of prolonged hospital stays and may even lead to death in 5.0-20.0% of cases [9,12].…”

History of Issue, Epidemiological and Surgical Aspects of Acute Large Bowel Obstruction of Tumoral Genesis

“…According to the literature, the failure of the primary formed anastomosis of the large intestine in conditions of obstruction ranges from 25.1-69.2% [25,27]. Based on this, in more than 50% of patients, surgical interventions end with the formation of a colostomy, more often according to Hartmann.…”