A collaborative review of the current concepts and challenges of anastomotic leaks in colorectal surgery.
The reduction of the incidence, detection and treatment of anastomotic leakage (AL) continues to challenge the colorectal surgical community. AL is not consistently defined and reported in clinical studies, its occurrence is variably reported and its impact on longterm morbidity and health-care resources has received relatively little attention. Controversy continues regarding the best strategies to reduce the risk. Diagnostic tests lack sensitivity and specificity, resulting in delayed diagnosis and increased morbidity. Intra-operative fluorescence angiography has recently been introduced as a means of real-time assessment of anastomotic perfusion and preliminary evidence suggests that it may reduce the rate of AL. In addition, concepts are emerging about the role of the rectal mucosal microbiome in AL and the possible role of new prophylactic therapies. In January 2016 a meeting of expert colorectal surgeons and pathologists was held in London, UK, to identify the ongoing controversies surrounding AL in colorectal surgery. The outcome of the meeting is presented in the form of research challenges that need to be addressed.
Royal College of Surgeons of England, London, UK.
A
A
Vallance
Cleveland Clinic Florida, Weston, Florida, USA.
S
S
Wexner
Cleveland Clinic Florida, Weston, Florida, USA.
M
M
Berho
University College Dublin, Dublin, Ireland.
R
R
Cahill
Derriford Hospital, Plymouth, UK.
M
M
Coleman
University Hospital of South Manchester, Manchester, UK.
N
N
Haboubi
Basingstoke and North Hampshire Hospital, Basingstoke, UK.
R J
RJ
Heald
St Mark's Hospital, London, UK.
R H
RH
Kennedy
Basingstoke and North Hampshire Hospital, Basingstoke, UK.
B
B
Moran
Oxford University Hospitals, Oxford, UK.
N
N
Mortensen
The ICENI Centre, Colchester University Hospital, Colchester, UK.
R W
RW
Motson
The Royal Free Hospital, London, UK.
R
R
Novell
University College Dublin, Dublin, Ireland.
P R
PR
O'Connell
Geneva University Hospitals and Medical School, Geneva, Switzerland.
F
F
Ris
Royal Surrey County Hospital, Guildford, UK.
T
T
Rockall
Portsmouth Hospitals, Portsmouth, UK.
A
A
Senapati
University College Hospital, London, UK.
A
A
Windsor
University of Leeds, Leeds, UK.
D G
DG
Jayne
D057868:Anastomotic Leak; D003107:Colorectal Surgery / Q000639:trends*; D004766:Enterostomy / Q000009:adverse effects*; D006801:Humans; D006113:United Kingdom