World Journal of Laparoscopic Surgery

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VOLUME 8 , ISSUE 2 ( May-August, 2015 ) > List of Articles

REVIEW ARTICLE

Anastomotic Leak in Laparoscopic Colorectal Surgery: Risk Factors and Prevention

Abdullah Badawi

Citation Information : Badawi A. Anastomotic Leak in Laparoscopic Colorectal Surgery: Risk Factors and Prevention. World J Lap Surg 2015; 8 (2):43-47.

DOI: 10.5005/jp-journals-10033-1245

Published Online: 01-08-2015

Copyright Statement:  Copyright © 2015; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background

Anastomotic leakage (AL) is a common complication and still is a significant problem following laparoscopic colorectal surgery. Risk factors and prevention for AL are not well-defined.

Methods

A systematic search of electronic databases. Cohort, case-control studies and randomized controlled trials that examined clinical risk factors and prevention for AL were included.

Conclusions

In conclusion, tumor location. ≤6 cm from the anal verge, tumor size > 5 cm, preservation of the left colic artery, male gender, severe malnutrition, body mass index (BMI). ≥25, preoperative Neoadjuvant therapy and steroid therapy, American Society of Anesthesiologists (ASAs) score. ≥3, tobacco abuse, operating time. ≥180 minutes, precompression before stapler firing and multiple firing of the stapler are associated with increase the risk of developing AL. On the other hand, Improve nutritional status, control comorbidities, stop smoking at least 2 weeks before surgery and preoperative use of mechanical bowel preparation, assessment and subsequent adaptation of operative technique without multiple firings of stapler or precompression before stapler firings and the use of transanal tube postoperatively, showed decrease in the al rate following laparoscopic colorectal procedures.

How to cite this article

Badawi A. Anastomotic Leak in Laparoscopic Colorectal Surgery: Risk Factors and Prevention. World J Lap Surg 2015;8(2):43-47.


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  1. The low stapled anastomosis. Br J Surg 1981;68(5):333-337.
  2. Laparoscopic colorectal anastomosis: risk of postoperative leakage. Results of a multicenter study. Laparoscopic Colorectal Surgery Study Group (LCSSG). Surg Endosc 1999;13(7):639-644.
  3. Risk factors and outcomes for anastomotic leakage in colorectal surgery: a single-institution analysis of 1576 patients. World J Surg 2011;35(1):186-195.
  4. Anastomotic leaks in colorectal surgery. ANZ J Surg 2014;84(10):763-768.
  5. Total mesorectal excision is not necessary for cancers of the upper rectum. Surg 1998;124(4):612-617;discussion 617-618.
  6. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 1998;85(3):355-358.
  7. Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1,014 patients. J Am Coll Surg 1997;185(2):105-113.
  8. Laparoscopy-assisted colectomy vs open colectomy for treatment of nonmetastatic colon cancer: a randomised trial. Lancet 2002;359(9325):2224-2229.
  9. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 2005;365(9472):1718-1726.
  10. Laparoscopic surgery vs open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 2005;6(7):477-484.
  11. Risk factors for anastomotic leakage after low anterior resection with total mesorectal excision. Am J Surg 2000;179(2):92-96.
  12. Anastomotic leakage after lower gastrointestinal anastomosis: men are at a higher risk. ANZ J Surg 2006;76(7):579-585.
  13. The nutritional risk is a independent factor for postoperative morbidity in surgery for colorectal cancer. Ann Surg Treat Res 2014;86(4):206-211.
  14. A multivariate analysis of factors contributing to leakage of intestinal anastomoses. J Am Coll Surg 1997;184(4):364-372.
  15. Anterior resection for rectal carcinoma-risk factors for anastomotic leaks and strictures. World J Gastroenterol 2011;17(11):1475-1479.
  16. Colonic anastomotic leak: risk factors, diagnosis, and treatment. J Am Coll Surg 2009;208(2):269-278.
  17. Preoperative hypoalbuminemia in colorectal cancer patients undergoing elective surgery—a major risk factor for postoperative outcome. Chirurgia (Bucur) 2013;108(6):822-828.
  18. Definitive risk factors for anastomotic leaks in elective open colorectal resection. Arch Surg 2008;143(9):907-911.
  19. Factors associated with clinically significant anastomotic leakage after large bowel resection: multivariate analysis of 707 patients. World J Surg 2002;26(4):499-502.
  20. Risk factors for anastomotic leak following colorectal surgery: a case-control study. Arch Surg 2010;145(4):371-376.
  21. Risk factors for anastomotic leakage following anterior resection for colorectal cancer: the effect of epidural analgesia on occurrence. Int J Colorectal Dis 2013;28(4):485-492.
  22. Factors influencing the outcome of intestinal anastomosis. Am Surg 2011;77(9):1169-1175.
  23. Blood transfusion impairs the healing of experimental intestinal anastomoses. Ann Surg 1992;215(3):276-281.
  24. Risk factors and outcomes for anastomotic leakage in colorectal surgery: a single-institution analysis of 1576 patients. World J Surg 2011;35(1):186-195.
  25. Leakage after resection and intraperitoneal anastomosis for colorectal malignancy: analysis of risk factors. Dis Colon Rectum 2006;49(11):1719-1725.
  26. Management of anastomotic leakage after nondiverted large bowel resection. J Am Coll Surg 1999;189(6):554-559.
  27. Anastomotic dehiscence after resection and primary anastomosis in left-sided colonic emergencies. Dis Colon Rectum 2005;48(12):2272-2280.
  28. Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis. Dis Colon Rectum 2003;46(5):653-660.
  29. Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study. Int J Colorectal Dis 2008;23(3):265-270.
  30. Risk factors for anastomotic leakage and leak-related mortality after colonic cancer surgery in a nationwide audit. Br J Surg 2014;101(4):424-432.
  31. Risk factors for anastomotic leakage after surgery for colorectal cancer: results of prospective surveillance. J Am Coll Surg 2006;202(3):439-444.
  32. Effect of systemic corticosteroids on elective left-sided colorectal resection with colorectal anastomosis. Am J Surg 2008;195(4):447-451.
  33. Long-term and perioperative corticosteroids in anastomotic leakage: a prospective study of 259 left-sided colorectal anastomoses. Arch Surg 2012;147(5):447-452.
  34. Efficacy of transanal tube for prevention of anastomotic leakage following laparoscopic low anterior resection for rectal cancers: a retrospective cohort study in a single institution. Surg Endosc 2015 Apr;29(4):863-867.
  35. Nomogram to predict anastomotic leakage after laparoscopic anterior resection with intracorporeal rectal transection and double-stapling technique anastomosis for rectal cancer. Hepatogastroenterology 2014 Jul-Aug;61(133):1257-1261.
  36. Risk assessment on anastomotic leakage after rectal cancer surgery: an analysis of 753 patients. Asian Pac J Cancer Prev 2013;14(7):4447-4453.
  37. Risk factors for anastomotic leakage after laparoscopic low anterior resection with DST anastomosis. Surg Endosc 2014 Oct;28(10):2996-2997.
  38. Clinical risk factors for anastomotic leakage after laparoscopic anterior resection for rectal cancer: a systemati review and meta-analysis. Surg Endosc, 2015 Mar 6. [Epub ahead of print].
  39. Outcome of anastomotic leakage after colorectal surgery in patients with or without preoperative mechanical bowel irrigation: an observational study. Surgical Science 2012;3:105-110.
  40. The first laparoscopic cholecystectomy. J Soc Laparoendosc Surg 2001;5 (1). p. 89-94.
  41. Minimally invasive colon resection (laparoscopic colectomy). Surgical laparoscopy andamp; Endoscopy 1991;1(3):144-150.
  42. Subcutaneous metastases after laparoscopic colectomy. Lancet 1994;344(8914):58.
  43. Survival after laparoscopic surgery vs opensurgery for colon cancer long-term outcome of a randomised clinical trial. Lancet Oncol 2009;10(1):44-52.
  44. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg 2007;246(4):655-662.
  45. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: Three-year results of the UK MRC CLASICC trial group. J Clin Oncol 2007;25(21):3061-3068.
  46. The long-term results of a randomized clinical trial of laparoscopy-assisted vs open surgery for colon cancer. Ann Surg 2008;248(1):1-7.
  47. Experience with 969 minimal access colectomies: the role of hand-assisted laparoscopy in expanding minimally invasive surgery for complex colectomies. J Am College Surg 2008;206(5):946-950.
  48. Single-incision laparoscopic surgery (SILS) in general surgery: a review of current practice. Surg Laparosc Endosc Percutan Techniq 2010;20(4):191-204.
  49. Multicentric study on robotic tumor-specific mesorectal excision for the treatment of rectal cancer. Ann Surg Oncol 2010;17(6):1614-1620.
  50. Robotic colon and rectal surgery: a series of 131 cases. World J Surg 2010;34(8):1954-1958.
  51. Transvaginal colonic extraction following combined hysterectomy and laparoscopic total colectomy: a natural orifice approach. Techniques in Coloproctology 2008;12(3):251-254.
  52. Laparoscopicassisted sigmoidectomy with transanal specimen extraction: a bridge to NOTES? Techniques in Coloproctology 2009;13(1):65-68.
  53. Clinical outcome of laparoscopic right hemicolectomy with transvaginal resection, anastomosis, and retrieval of specimen. Dis Colon and Rectum 2010;53(11):1473-1479.
  54. Laparoscopic sigmoid resection with transrectal specimen extraction has a good short-term outcome. Surg Endosc 2011;25(6):2034-2038.
  55. Management and outcome of anastomotic leakage after colonic surgery. Colorectal Dis 2010;12(10 online):e216-223.
  56. Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study. Int J Colorectal Dis 2008;23(3):265-270.
  57. Pelvic drainage and other risk factors for leakage after elective anterior resection in rectal cancer patients: a prospective study of 978 patients. Ann Surg 2005;241(1):9-13.
  58. Anastomotic leaks after intestinal anastomosis: it's later than you think. Ann Surg 2007;245(2):254-258.
  59. Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum. Br J Surg 1994;81(8):1224-1226.
  60. Predicting risk and diminishing the consequences of anastomotic dehiscence following rectal resection. Colorectal Dis 2003;5(5):478-482.
  61. Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg 2001;88(9):1157-1168.
  62. Definition and 12 grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International study group of rectal cancer. Surg 2010;147(3):339-351.
  63. Risk factors for anastomotic leakage after laparoscopic low anterior resection with DST anastomosis. Surg Endosc 2014 Oct;28(10):2988-2995.
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