Anastomotic leakage following low anterior resection: results of a standardized diagnostic and therapeutic approach.
OBJECTIVE
This study analyzed the results of a standardized approach in anastomotic leakage following low anterior resection for rectal cancer without performance of a protective ileostomy during the primary operation.


METHODS
The study included all 306 patients with rectal cancer electively undergoing low anterior resection with retroperitonealization of the anastomosis over 9 years. The diagnostic procedure for anastomotic leakage included serum laboratory investigations and abdominal CT together with contrast enema. Minor leakages, i.e., small leakages and pelvic abscess, were treated with rectoscopic lavage and/or CT-guided drainage of the abscess, respectively. Major leakage was defined as broad insufficiency with or without septicemia. Nonseptic patients were treated by ileostomy and rectoscopic treatment. In septic patients a revision of the anastomosis with loop ileostomy was performed.


RESULTS
Anastomotic leakage was diagnosed in 30 patients (overall 9.8%; 12 major, 18 minor leakages). Common clinical signs were pelvic pain and fever. No patient developed a peritonitis. The most accurate diagnostic instrument was CT (96.7%).


CONCLUSIONS
Retroperitonealization appears to prevent peritonitis in patients with anastomotic leakage following low anterior resection. A differential treatment leads to good results in terms of mortality and anorectal function.
Eckmann
C
C
Department of Surgery, Medical University Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany. chr.eckmann@gmx.de
Kujath
P
P
Schiedeck
T H K
TH
Shekarriz
H
H
Bruch
H-P
HP
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery; D012086:Reoperation; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D016896:Treatment Outcome