Non-operative treatment of anastomotic leaks: Current and investigational therapies

Abstract

The treatment of anastomotic leaks remains primarily operative; however, recent advances in technology are changing the scope of non-operative interventions for managing this difficult complication. The authors sought to provide an evidence-based review of the non-operative treatment options for anastomotic leaks using both current guidelines and investigational modalities on the horizon. A search of MEDLINE, PubMed, and the Cochrane Database of relevant scientific papers and reviews was performed. Abstracts were reviewed to determine their scientific merit and relevance to non-operative treatment of anastomotic leaks. Recommendations and treatment algorithms were based on consensus conclusions of the data. A total of 87 articles were reviewed and analyzed for this article. Reoperation is the first-line therapy for many anastomotic leaks, but non-operative techniques are appropriate and effective for a subset of this population. Image-guided percutaneous drainage has changed the treatment paradigm for many patients with anastomotic leaks. Endoscopic drainage and stenting are in their infancy, and controlled trials are needed to prove their efficacy; however, the future of non-operative treatment appears promising.