[Anastomotic leakage following anterior resection for rectal carcinoma].
With the improvement of surgical techniques anterior resection with the preservation of the anal sphincter has become the preferred operative option for rectal cancer. This procedure is associated with the problem of anastomotic leakage (AL). The reported rate of symptomatic AL is 1-29% but 20-77% of AL do not produce any typical clinical symptoms. Risk factors of AL involve: older patient's age, male gender, low site of anastomosis, pre-operative radiation, emergency admissions, major intraoperative bleeding, concomitant diseases and perioperative blood transfusion. Apart from clinical examination and peripheral blood tests, contrast enema, endoscopy, transrectal sonography and CT imaging can be helpful to diagnose AL. Minor AL may be usually managed conservatively, intra-abdominal abscess can in most cases can be treated by radiologically guided drainage. Major AL and cases with peritonitis require relaparotomy. The risk of permanent stoma after AL is 25-30%. AL-related mortality is reported from 0 to 40%. Effectiveness of surgical techniques potentially protecting the anastomosis, as defunctioning stoma, suction-irrigation drainage, omentoplasty, no-suction pelvic drainage and transanal decompressive tubbing is still not proven and remains disputable. Impact of AL on functional results is not unequivocally cleared. AL may significantly increase local recurrence rate and should be considered as an independent prognostic factor influencing poor long-term survival.
Grzebieniak
Zygmunt
Z
Katedra i Klinika Chirurgii Ogólnej, i Onkologicznej Akademii Medycznej, im.Piastów Slaskich we Wroctawiu, Kierownik. chir2@chir2.am.wroc.pl
Szynglarewicz
Barttomiej
B
D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D003107:Colorectal Surgery / Q000009:adverse effects* / Q000379:methods* / Q000401:mortality; D003125:Colostomy / Q000009:adverse effects / Q000379:methods; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome