title: Anastomotic leakage after gastrointestinal surgery: diagnosis and management.
abstract: Anastomotic leakage represents a major complication of gastrointestinal surgery, leading to increased postoperative morbidity; it the foremost cause of mortality after intestinal resection. Identification of risk factors is essential for the prevention of AL. AL can present with various clinical pictures, ranging from the absence of symptoms to life-threatening septic shock. Contrast-enhanced CT scan is the most complete investigation to define AL and its consequences. Early and optimal multidisciplinary management is based on three options: medical management, radiologic or endoscopic intervention, or surgical re-intervention. Prompt treatment should help decrease postoperative morbidity and mortality, with the choice depending on the septic status of the patient. If the patient is asymptomatic, treatment can be medical only, coupled with close surveillance. Interventional management is indicated when the fistula is symptomatic but not life-threatening. On the other hand, when the vital prognosis is engaged, surgery is indicated, emergently, associated with intensive care. Even more than their prevention, early and appropriate management counts most to decrease their consequences.
authors.affiliation: Service de chirurgie générale, hôpital de la Croix-Rousse, 103, Grande-rue-de-la-Croix-Rousse, 69004 Lyon, France.
authors.forename: E
authors.initials: E
authors.lastname: Girard
authors.affiliation: Service de chirurgie digestive et générale, hôpital Claude-Huriez, centre hospitalier régional et universitaire, place de Verdun, 59037 Lille cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Messager
authors.affiliation: Service de chirurgie hépatique et pancréatique, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
authors.forename: A
authors.initials: A
authors.lastname: Sauvanet
authors.affiliation: Service de chirurgie oncologique et digestive, hôpital Kremlin-Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
authors.forename: S
authors.initials: S
authors.lastname: Benoist
authors.affiliation: Service de chirurgie digestive et générale, hôpital Claude-Huriez, centre hospitalier régional et universitaire, place de Verdun, 59037 Lille cedex, France.
authors.forename: G
authors.initials: G
authors.lastname: Piessen
authors.affiliation: Service de chirurgie générale, hôpital de la Croix-Rousse, 103, Grande-rue-de-la-Croix-Rousse, 69004 Lyon, France.
authors.forename: J-Y
authors.initials: JY
authors.lastname: Mabrut
authors.affiliation: Service de chirurgie digestive et générale, hôpital Claude-Huriez, centre hospitalier régional et universitaire, place de Verdun, 59037 Lille cedex, France. Electronic address: christophe.mariette@chru-lille.fr.
authors.forename: C
authors.initials: C
authors.lastname: Mariette
mesh_terms: D057868:Anastomotic Leak / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D003131:Combined Modality Therapy; D013505:Digestive System Surgical Procedures; D006801:Humans; D012307:Risk Factors
keywords: Anastomotic leakage; Colon rectum; Diagnosis; Esophagus; Pancreas; Review; Stomach; Treatment