Abstract
BackgroundThere is still no consensus on the management of colorectal anastomotic leakage after low anterior resection. The goal was to evaluate the outcomes of patients who underwent transanal endoluminal repair + laparoscopic drainage ± stoma vs. drainage only ± stoma.MethodsRetrospective chart review of patients sustaining anastomotic leakage after laparoscopic low anterior resection between January 2013 and September 2020 who required laparoscopic reoperation.ResultsForty-nine patients were included, 22 patients underwent combined laparoscopy and transanal endoluminal repair and 27 patients had drainage with a stoma (n = 16) or drainage alone (n = 11), without direct anastomotic repair. The overall morbidity rate was 30.6% and the mortality rate was 2%. Combined laparoscopic lavage/drainage and transanal endoluminal repair of anastomotic leakage was associated with a lower complication rate (13.6% vs. 44.4%, p = 0.03) and fewer intraabdominal infections (4.5% vs. 29.6%, p = 0.03) compared with no repair.ConclusionsCombined laparoscopic lavage/drainage and transanal endoluminal repair is effective in the management of colorectal anastomosis leakage and was associated with lower morbidity—in particular intraabdominal infection—compared with no repair. However, our results need to be confirmed in larger, and ideally randomized, studies.
Highlights
Anastomotic leakage is one of the most dreaded complications after elective colorectal surgery and is associated with high morbidity, mortality and poor oncological outcome [1,2,3,4]
We have previously reported that combined repeat laparoscopy and transanal endoluminal anastomosis repair after colorectal anastomosis leakage was safe and feasible [12, 13]
Our study found that laparoscopic reintervention with anastomotic preservation for the management of colorectal anastomotic leakage was a viable option in 49 patients, thanks to early revisional surgery
Summary
Anastomotic leakage is one of the most dreaded complications after elective colorectal surgery and is associated with high morbidity, mortality and poor oncological outcome [1,2,3,4]. Extra-peritoneum anastomosis failure calls for resection with end stoma creation, but which is. To the best of our knowledge, no studies have compared outcomes of patients who undergo laparoscopic anastomotic repair in comparison to those who are treated by simple drainage and. The goal of our study is to compare re-laparoscopic lavage/ draingage + transanal endoluminal repair ± stoma vs drainage ± stoma. The goal was to evaluate the outcomes of patients who underwent transanal endoluminal repair + laparo‐ scopic drainage ± stoma vs drainage only ± stoma
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