Surgical management and long-term functional outcomes after anastomotic leak in patients undergoing minimally invasive restorative rectal resection and without a diverting ileostomy.

Abstract

Anastomotic leak (AL) is the anathema of colorectal surgery, with well-documented adverse impacts on patient morbidity and mortality. The long-term consequences of AL on bowel function and quality of life (QoL) is less well-defined after minimally invasive surgery. By omitting a temporary diverting ileostomy (TDI), it is postulated that the minimally invasive approach will lead to early diagnosis and expedient management of AL. This retrospective and cross-sectional study included patients who underwent minimally invasive restorative rectal surgery with a low pelvic colorectal anastomosis and without a TDI at two tertiary hospitals in Brisbane, Australia between 2004 and 2018. Surgical management of AL is described and long-term functional outcomes were evaluated through validated questionnaires. Two hundred and twenty-four patients met inclusion criteria. AL was associated with lesion proximity to the anal verge (P=0.011), total mesorectal excision (TME) (P <0.001) and advanced malignant disease (P=0.019). Twenty-four patients experienced an AL (11%) diagnosed at a median of 5.5 days post-operative. Survey responders (n=99, 62%) included 10 (10%) AL and 89 (90%) non-AL patients, with a median follow-up of 4 and 6.4 years. SF-36 and FISI scores were comparable between groups, however AL patients had worse LARS scores (P=0.028). Patients undergoing TME, irrespective of AL, had poorer low anterior resection syndrome (LARS) (P <0.001) and FISI scores (P=0.001). AL in patients undergoing minimally invasive low pelvic colorectal anastomosis without a TDI does not impact long term QoL. The occurrence of LARS is dependent on the extent of resection, rather than the occurrence of AL.