Top

International Journal of Colorectal Disease

Published in:

Open Access 01-04-2017 | Original Article

Diagnosis, treatment, and consequences of anastomotic leakage in colorectal surgery

Authors: Bodil Gessler, Olle Eriksson, Eva Angenete

Published in: International Journal of Colorectal Disease | Issue 4/2017

Abstract

Purpose

The aim of this study was to explore the choice of modality for diagnosis, treatments, and consequences of anastomotic leakage.

Methods

This is a retrospective study of consecutive patients who underwent surgery that included a colorectal anastomosis due to colorectal cancer, diverticulitis, inflammatory bowel disease (IBD), or benign polyps.

Results

A total of 600 patients were included during 2010–2012, and 60 (10%) had an anastomotic leakage. It took in mean 8.8 days (range 2–42) until the anastomotic leakage was diagnosed. A total of 44/60 of the patients with a leakage had a CT scan of the abdomen; 11 (25%) were initially negative for anastomotic leakage. Among all leakages, the anastomosis was taken down in 45 patients (76.3%). All patients with a grade B leakage (n = 6) were treated with antibiotics, and two also received transanal drainage. The overall complication rate was also significantly higher in those with leakage (93.3 vs. 28.5%, p < 0.001), and it was more common with more than three complications (70 vs. 1.5%, p < 0.001). There was a higher mortality in the leakage group.

Conclusion

This study demonstrated that one fourth of the CT scans that were executed were initially negative for leakage. Most patients with a grade C leakage will not have an intact anastomosis. An anastomotic leakage leads to significantly more severe postoperative complications, higher rate of reoperations, and higher mortality. An earlier relaparotomy instead of a CT scan and improved postoperative surveillance could possibly reduce the consequences of the anastomotic leakage.

Ashburn JH, Stocchi L, Kiran RP et al (2013) Consequences of anastomotic leak after restorative proctectomy for cancer: effect on long-term function and quality of life. Dis Colon rectum 56(3):275–280CrossRefPubMed

Di Cristofaro L, Ruffolo C, Pinto E et al (2014) Complications after surgery for colorectal cancer affect quality of life and surgeon-patient relationship. Color Dis 16(12):O407–O419CrossRef

Thornton M, Joshi H, Vimalachandran C et al (2011) Management and outcome of colorectal anastomotic leaks. Int J Color Dis 26(3):313–320CrossRef

Buchs NC, Gervaz P, Secic M et al (2008) Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study. Int J Color Dis 23(3):265–270CrossRef

Mirnezami A, Mirnezami R, Chandrakumaran K et al (2011) Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg 253(5):890–899CrossRefPubMed

Law WL, Choi HK, Lee YM et al (2007) Anastomotic leakage is associated with poor long-term outcome in patients after curative colorectal resection for malignancy. J Gastrointest Surg 11(1):8–15CrossRefPubMed

McArdle CS, McMillan DC, Hole DJ (2005) Impact of anastomotic leakage on long-term survival of patients undergoing curative resection for colorectal cancer. Br J Surg 92(9):1150–1154CrossRefPubMed

Branagan G, Finnis D (2005) Prognosis after anastomotic leakage in colorectal surgery. Dis Colon rectum 48(5):1021–1026CrossRefPubMed

Krarup PM, Nordholm-Carstensen A, Jorgensen LN et al (2014) Anastomotic leak increases distant recurrence and long-term mortality after curative resection for colonic cancer: a nationwide cohort study. Ann Surg 259(5):930–938CrossRefPubMed

10.

Kube R, Mroczkowski P, Granowski D et al (2010) Anastomotic leakage after colon cancer surgery: a predictor of significant morbidity and hospital mortality, and diminished tumour-free survival. Eur J Surg Oncol 36(2):120–124CrossRefPubMed

11.

Nachiappan S, Askari A, Malietzis G et al (2015) The impact of anastomotic leak and its treatment on cancer recurrence and survival following elective colorectal cancer resection. World J Surg 39(4):1052–1058CrossRefPubMed

12.

Bakker IS, Grossmann I, Henneman D et al (2014) Risk factors for anastomotic leakage and leak-related mortality after colonic cancer surgery in a nationwide audit. Br J Surg 101(4):424–432 discussion 432CrossRefPubMed

13.

Krarup PM, Jorgensen LN, Andreasen AH et al (2012) A nationwide study on anastomotic leakage after colonic cancer surgery. Color Dis 14(10):e661–e667CrossRef

14.

Matthiessen P, Hallbook O, Rutegard J et al (2007) Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg 246(2):207–214CrossRefPubMedPubMedCentral

15.

Bertelsen CA, Andreasen AH, Jorgensen T et al (2010) Anastomotic leakage after anterior resection for rectal cancer: risk factors. Color Dis 12(1):37–43CrossRef

16.

Eriksen MT, Wibe A, Norstein J et al (2005) Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients. Color Dis 7(1):51–57CrossRef

17.

Alves A, Panis Y, Bouhnik Y et al (2007) Risk factors for intra-abdominal septic complications after a first ileocecal resection for Crohn’s disease: a multivariate analysis in 161 consecutive patients. Dis Colon rectum 50(3):331–336CrossRefPubMed

18.

Boccola MA, Buettner PG, Rozen WM et al (2011) Risk factors and outcomes for anastomotic leakage in colorectal surgery: a single-institution analysis of 1576 patients. World J Surg 35(1):186–195CrossRefPubMed

19.

Choi HK, Law WL, Ho JW (2006) Leakage after resection and intraperitoneal anastomosis for colorectal malignancy: analysis of risk factors. Dis Colon rectum 49(11):1719–1725CrossRefPubMed

20.

Kingham TP, Pachter HL (2009) Colonic anastomotic leak: risk factors, diagnosis, and treatment. J Am Coll Surg 208(2):269–278CrossRefPubMed

21.

Pommergaard HC, Gessler B, Burcharth J, et al. (2014) Preoperative risk factors for anastomotic leakage after resection for colorectal cancer: a systematic review and meta-analysis. Colorectal Dis

22.

Matthiessen P, Hallbook O, Andersson M et al (2004) Risk factors for anastomotic leakage after anterior resection of the rectum. Color Dis 6(6):462–469CrossRef

23.

Kruschewski M, Rieger H, Pohlen U et al (2007) Risk factors for clinical anastomotic leakage and postoperative mortality in elective surgery for rectal cancer. Int J Color Dis 22(8):919–927CrossRef

24.

Konishi T, Watanabe T, Kishimoto J et al (2006) Risk factors for anastomotic leakage after surgery for colorectal cancer: results of prospective surveillance. J Am Coll Surg 202(3):439–444CrossRefPubMed

25.

Komen N, Dijk JW, Lalmahomed Z et al (2009) After-hours colorectal surgery: a risk factor for anastomotic leakage. Int J Color Dis 24(7):789–795CrossRef

26.

Jestin P, Pahlman L, Gunnarsson U (2008) Risk factors for anastomotic leakage after rectal cancer surgery: a case-control study. Color Dis 10(7):715–721CrossRef

27.

Rahbari NN, Weitz J, Hohenberger W et al (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 147(3):339–351CrossRefPubMed

28.

Hirst NA, Tiernan JP, Millner PA et al (2014) Systematic review of methods to predict and detect anastomotic leakage in colorectal surgery. Color Dis 16(2):95–109CrossRef

29.

Floodeen H, Hallbook O, Rutegard J et al (2013) Early and late symptomatic anastomotic leakage following low anterior resection of the rectum for cancer: are they different entities? Color Dis 15(3):334–340CrossRef

30.

Maeda H, Okamoto K, Namikawa T et al (2015) Rarity of late anastomotic leakage after low anterior resection of the rectum. Int J Color Dis 30(6):831–834CrossRef

31.

Hyman N, Manchester TL, Osler T et al (2007) Anastomotic leaks after intestinal anastomosis: it’s later than you think. Ann Surg 245(2):254–258CrossRefPubMedPubMedCentral

32.

Morks AN, Ploeg RJ, Sijbrand Hofker H et al (2013) Late anastomotic leakage in colorectal surgery: a significant problem. Color Dis 15(5):e271–e275CrossRef

33.

Tan WP, Hong EY, Phillips B et al (2014) Anastomotic leaks after colorectal anastomosis occurring more than 30 days postoperatively: a single-institution evaluation. Am Surg 80(9):868–872PubMed

34.

Sirois-Giguere E, Boulanger-Gobeil C, Bouchard A et al (2013) Transanal drainage to treat anastomotic leaks after low anterior resection for rectal cancer: a valuable option. Dis Colon Rectum 56(5):586–592CrossRefPubMed

35.

Blumetti J, Chaudhry V, Cintron JR et al (2014) Management of anastomotic leak: lessons learned from a large colon and rectal surgery training program. World J Surg 38(4):985–991CrossRefPubMed

36.

Krarup PM, Jorgensen LN, Harling H (2014) Management of anastomotic leakage in a nationwide cohort of colonic cancer patients. J Am Coll Surg 218(5):940–949CrossRefPubMed

37.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentral

38.

Kauv P, Benadjaoud S, Curis E, et al. (2015) Anastomotic leakage after colorectal surgery: diagnostic accuracy of CT. Eur Radiol

39.

Kornmann VN, van Ramshorst B, Smits AB et al (2014) Beware of false-negative CT scan for anastomotic leakage after colonic surgery. Int J Color Dis 29(4):445–451CrossRef

40.

den Dulk M, Witvliet MJ, Kortram K et al (2013) The DULK (Dutch leakage) and modified DULK score compared: actively seek the leak. Color Dis 15(9):e528–e533

41.

Garcia-Granero A, Frasson M, Flor-Lorente B et al (2013) Procalcitonin and C-reactive protein as early predictors of anastomotic leak in colorectal surgery: a prospective observational study. Dis Colon rectum 56(4):475–483CrossRefPubMed

42.

Singh PP, Zeng IS, Srinivasa S et al (2014) Systematic review and meta-analysis of use of serum C-reactive protein levels to predict anastomotic leak after colorectal surgery. Br J Surg 101(4):339–346CrossRefPubMed

43.

Nygren J, Thacker J, Carli F et al (2013) Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS((R))) Society recommendations. World J Surg 37(2):285–305CrossRefPubMed

44.

Gessler B, Bock D, Pommergaard HC et al (2016) Risk factors for anastomotic dehiscence in colon cancer surgery-a population-based registry study. Int J Color Dis 31(4):895–902CrossRef

Title: Diagnosis, treatment, and consequences of anastomotic leakage in colorectal surgery
Authors: Bodil Gessler
Olle Eriksson
Eva Angenete
Publication date: 01-04-2017
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 4/2017
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-016-2744-x

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Diagnosis, treatment, and consequences of anastomotic leakage in colorectal surgery

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2017

Long-term outcomes of colorectal endoscopic submucosal dissection in elderly patients

Effective and long-term outcome following ligation of the intersphincteric fistula tract (LIFT) for transsphincteric fistula

An open prospective study evaluating efficacy and safety of a new medical device for rectal application of activated carbon in the treatment of chronic, uncomplicated perianal fistulas

Successful treatment of pouchitis with Vedolizumab, but not fecal microbiota transfer (FMT), after proctocolectomy in ulcerative colitis

Liver test abnormalities predict complicated disease behaviour in patients with newly diagnosed Crohn’s disease

Is early colonoscopy after CT-diagnosed diverticulitis still necessary?