title: Management of anastomotic leak: lessons learned from a large colon and rectal surgery training program.
abstract: BACKGROUND
  Anastomotic leak is a dreaded surgical complication that can lead to significant morbidity and mortality. Despite its prevalence, there is no consensus on the management of anastomotic leak. This study aimed to review the management of anastomotic leak in the Division of Colon and Rectal Surgery at two institutions.
  
  
  METHODS
  This is a retrospective review of all anastomotic leaks occurring after surgery in the Division of Colon and Rectal Surgery at two teaching institutions during 1997-2008.
  
  
  RESULTS
  Altogether, 103 leaks occurred in 1,707 anastomoses (6 %), with a median time to diagnosis of 20 days (2-1,400 days). The 90-day mortality rate was 3 %. The majority of cases were managed nonoperatively (73 %), and the majority of leaks were from an extraperitoneal anastomosis (67 %). Success (i.e., radiographic demonstration of a healed leak, restored gastrointestinal continuity) occurred in 54 % of operatively managed leaks and 57 % of nonoperatively managed leaks (56 % overall). Operative management differed by leak location. In 91 % of patients with intraperitoneal leaks, the anastomosis was resected. In 76 % of patients with extraperitoneal leaks, diversion and drainage alone was performed without manipulating the anastomosis. Nonoperative management was successful for 57 % of extraperitoneal leaks and 58 % of intraperitoneal leaks. There was no significant difference in the success rates based on type of management (operative/nonoperative) for either extraperitoneal or intraperitoneal leaks.
  
  
  CONCLUSIONS
  Anastomotic leak continues to result in patient morbidity and mortality. Its diverse presentation requires tailoring management to the patient. Nonoperative and operative treatments are viable options for intraperitoneal and extraperitoneal leaks based on patient presentation.
authors.affiliation: Division of Colon and Rectal Surgery, Stroger Hospital of Cook County, 1900 W. Polk Street, Room 404, Chicago, IL, 60612, USA, jblumetti5@gmail.com.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Blumetti
authors.forename: Vivek
authors.initials: V
authors.lastname: Chaudhry
authors.forename: Jose R
authors.initials: JR
authors.lastname: Cintron
authors.forename: John J
authors.initials: JJ
authors.lastname: Park
authors.forename: Slawomir
authors.initials: S
authors.lastname: Marecik
authors.forename: Jacqueline L
authors.initials: JL
authors.lastname: Harrison
authors.forename: Leela M
authors.initials: LM
authors.lastname: Prasad
authors.forename: Herand
authors.initials: H
authors.lastname: Abcarian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003106:Colon / Q000601:surgery*; D003107:Colorectal Surgery / Q000193:education; D003131:Combined Modality Therapy; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006784:Hospitals, Teaching; D006801:Humans; D007081:Ileostomy; D007087:Illinois; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents