The management of leaking rectal anastomoses by minimally invasive techniques.
BACKGROUND
The salvage of a leaking rectal anastomosis has been reported in selected cases. Herein we present our experience in the management of rectal anastomotic dehiscence by minimally invasive techniques.


METHODS
A total of 94 patients underwent anterior rectal resection for rectal cancer in an 18-month period. The operation was laparoscopic-assisted in 76 cases (81%).


RESULTS
Clinical anastomotic dehiscences occurred in 10 cases (10.6%). Conservative therapy, including the percutaneous drainage of pelvic abscesses, was successful in three cases. Among the seven patients who required reoperation, the anastomosis was taken down in only one case. In four of these cases, the reoperation was performed laparoscopically, including peritoneal lavage and the creation of a diverting stoma. There were no complications resulting from the use of laparoscopy in the early postoperative period. Closure of the stoma was possible in eight patients.


CONCLUSIONS
The salvage of a leaking rectal anastomosis is feasible in the vast majority of these cases (80%). The combination of laparoscopy and interventional radiology is a good alternative to laparotomy in patients who have had previous laparoscopic rectal excision.
Pera
M
M
Department of Gastrointestinal Surgery, Institute of Digestive Diseases, Hospital Clinic of Barcelona, Villarroel 170, Barcelona 08036, Spain. 28370mpr@comb.es
Delgado
S
S
García-Valdecasas
J C
JC
Pera
M
M
Castells
A
A
Piqué
J M
JM
Bombuy
E
E
Lacy
A M
AM
D000038:Abscess / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects* / Q000379:methods*; D004322:Drainage / Q000379:methods; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010533:Peritoneal Lavage / Q000379:methods; D015641:Radiography, Interventional / Q000379:methods; D012002:Rectal Diseases / Q000601:surgery; D012004:Rectal Neoplasms / Q000532:radiotherapy / Q000601:surgery; D012086:Reoperation / Q000379:methods; D016879:Salvage Therapy / Q000379:methods; D013529:Surgical Wound Dehiscence / Q000601:surgery*