Management of Low Colorectal Anastomotic Leakage in the Laparoscopic Era: More Than a Decade of Experience

BACKGROUND: Anastomotic leak after colorectal surgery increases postoperative mortality, cancer recurrence, permanent stoma formation, and poor bowel function. Anastomosis between the colon and rectum is a particularly high risk. Traditional management mandates laparotomy, disassembly of the anastomosis, and formation of an often-permanent stoma. After laparoscopic colorectal surgery it may be possible to manage anastomotic failure with laparoscopy, thus avoiding laparotomy. OBJECTIVE: The purpose of this study was to determine the feasibility of the laparoscopic management of failed low colorectal anastomoses. SETTING: This was a single-institute case series. PATIENTS: A total of 555 laparoscopic patients undergoing anterior resection with primary anastomosis within 10 cm of the anus in the period 2000–2012 were included. MAIN OUTCOME MEASURES: Anastomotic failure, defined as any clinical or radiological demonstrable defect in the anastomosis; complications using the Clavien–Dindo system; mortality within 30 days; and patient demographics and risk factors, as defined by the Charlson index, were measured. RESULTS: Leakage occurred in 44 (7.9%) of 555 patients, 16 patients with a diverting ileostomy and 28 with no diverting ileostomy. Leakage was more common in those with anastomoses

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