Slovenská chirurgia 2/2014

Leak of colorectal anastomosis

Leak of colorectal anastomosis is a feared complication which significantly increases morbidity, mortality and length of hospital stay. Average incidence of colorectal anastomosis leak is 11 % and increases with approximation of anastomosis to the anal verge. Development of anastomotic leak is related to localisation of the tumor, anastomotic distance from anal verge, surgical technique, type of colorectal (coloanal) anastomosis, intestinal microflora and many other factors. At present in clinical practice is not possible to reliably predict which anastomosis will leak. To avoid its serious complications many surgeons construct diverting stoma. However, despite extensive research, improvements of surgical technique and preoperative preparation, incidence of anastomotic leak remains at high rate. At the Clinic of surgery of University hospital in Martin in the period of years 2009 – 2013, 79 patients were electively operated undergoing low anterior resection of the rectum with colorectal anastomosis for rectal cancer. Retrospective analysis of the data were performed. Anastomotic leak (AL) were recorded in 14 (17 %) patients, therefrom in 3 (3,8 %) patients were asymptomatic. AL were classified as grade A in 8 (57 %) patients and as grade C in 6 (43 %) patients. 7 (50 %) ALs were recorded in patients with protective ileostomy and 4 (28,6 %) ALs in patients after neoadjuvant radiotherapy.

Keywords: anastomotic leak, rectal cancer, colorectal anastomosis, resection of the rectum, colorectal surgery.