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Review Article

Colorectal Anastomotic Leakage: A Review of Predictability Factors, Early Detection and Appropriate Management

Bikram Haldar , Bikram Haldar1 , Bitan Kumar Chattopadhyay2

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New Indian Journal of Surgery 10(1):p 107-116, January-February 2019. | DOI: DOI: https://dx.doi.org/10.21088/nijs.0976.4747.10119.18

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Abstract

 Objective: The purpose of this review article is to provide an insight to the recent recommendations in the field of colorectal surgery to yield a better outcome following colorectal anastomosis. Background: Anastomotic leak following colorectal resection surgery is associated with high rates of morbidity, mortality, and escalated healthcare expenditures. Knowledge about the factors predisposing patients to anastomotic leak is vital to its early detection and decision making for surgery. Early detection of the complications and its methodical management is vital for patient survival. Methodology: A literature search on colorectal surgery was carried out using PubMed, COCHRANE library and MEDLINE. Results: Current practice however should comprise pre-operative risk assessment and its optimization, subsequent adaptation of appropriate operative technique when necessary, intraoperative testing of the integrity of the anastomosis, use of diverting stoma in specific situations, avoid unnecessary use of pelvic drains and avoid preoperative bowel preparation. Absolute vigilance is a must for early detection of an anastomotic leak. Appropriate investigations and post-operative clinical scoring systems acts as a guide to help us salvage the situation. Conclusion: Anastomotic leaks still occur despite advancements made in preoperative optimization of the patient, surgical techniques, equipments, and post-operative management. Many attempts are being made to enhance the healthcare systems in regards to dealing with the anastomotic leaks and other colorectal surgery complications. Additionally future studies should aim at identification of other factors that may lead to anastomotic leak.

Keywords: Colorectal anastomosis technique; colorectal anastomotic leak; defunctioning stoma; Charlson Comorbidity Index; Colon Leakage Score (CLS); leak test; bowel preparation; drains in colorectal surgery; Dutch Leakage (DULK) Score.

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DOI: DOI: https://dx.doi.org/10.21088/nijs.0976.4747.10119.18

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