Anastomotic leakage in rectal surgery: Where are we and where do we go from here?

Abstract

Anastomotic leak in colorectal surgery is a significant complication which is feared by surgeons and has considerable consequences for patients. It affects up to 17% of rectal resections and although there is significant knowledge regarding its detection and treatment, there are still no reliable methods for its prevention. We proposed the routine use of intra-operative endoscopy as a method of reducing the risk of anastomotic leak. This thesis explores current knowledge regarding anastomotic leaks, including the causes, prevention and management. We also present the findings from a feasibility trial into intra-operative endoscopy as a method for reducing anastomotic leak rate. We found that the prevention of anastomotic leak is multi-faceted. Current methods cannot prevent it entirely but intra-operative endoscopy is a safe and potentially beneficial method of identifying leaks and preventing complications but further large-scale trials are required. If it cannot be prevented, early diagnosis and treatment is important to reduce further complications.