title: Management of failed low colorectal and coloanal anastomosis.
abstract: The most serious early complication after rectal resection with low anastomosis is anastomotic leakage (AL). AL may compromise the long-term conservation of the anastomosis and also worsen oncological results. The aim of this review was to identify those factors that contribute to the prevention of AL and to delineate the various treatment options (endoscopic, perineal surgical approach, abdominal surgical approach) for chronic AL or anastomotic stricture. Treatments for AL or anastomotic stricture should be protected by proximal diversion of fecal flow, ideally by a diverting stoma created at the time of the initial proctectomy. Local approaches to surgical treatment should include perineal examination under general anesthesia by the surgeon and drainage of the fistula. Trans-abdominal interventions should be reserved for high AL and for failure of perineal procedures. Although they have only limited indications for the treatment of AL, endoscopic treatments can be used in a complementary manner to surgical treatment. Balloon dilation is the first-line treatment for anastomotic strictures.
authors.affiliation: Service de chirurgie colorectale, Pôle des maladies de l'appareil digestif, Hôpital Beaujon, Assistance publique des Hôpitaux de Paris, Université Paris-VII (Denis Diderot), 100, boulevard du Général-Leclerc, 92118 Clichy cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Sabbagh
authors.forename: L
authors.initials: L
authors.lastname: Maggiori
authors.forename: Y
authors.initials: Y
authors.lastname: Panis
mesh_terms: D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D057868:Anastomotic Leak / Q000209:etiology* / Q000628:therapy; D003082:Colectomy / Q000009:adverse effects; D004322:Drainage / Q000379:methods; D006801:Humans; D012003:Rectal Fistula / Q000209:etiology* / Q000601:surgery; D012004:Rectal Neoplasms / Q000601:surgery; D012007:Rectum / Q000601:surgery*; D016896:Treatment Outcome
keywords: Anastomotic leak; Coloanal anastomosis; Fistula; Rectum