title: Diagnosis, treatment, and consequences of anastomotic leakage in colorectal surgery.
abstract: OBJECTIVE
  The aim of this study was to explore the choice of modality for diagnosis, treatments, and consequences of anastomotic leakage.
  
  
  METHODS
  This is a retrospective study of consecutive patients who underwent surgery that included a colorectal anastomosis due to colorectal cancer, diverticulitis, inflammatory bowel disease (IBD), or benign polyps.
  
  
  RESULTS
  A total of 600 patients were included during 2010-2012, and 60 (10%) had an anastomotic leakage. It took in mean 8.8 days (range 2-42) until the anastomotic leakage was diagnosed. A total of 44/60 of the patients with a leakage had a CT scan of the abdomen; 11 (25%) were initially negative for anastomotic leakage. Among all leakages, the anastomosis was taken down in 45 patients (76.3%). All patients with a grade B leakage (n = 6) were treated with antibiotics, and two also received transanal drainage. The overall complication rate was also significantly higher in those with leakage (93.3 vs. 28.5%, p < 0.001), and it was more common with more than three complications (70 vs. 1.5%, p < 0.001). There was a higher mortality in the leakage group.
  
  
  CONCLUSIONS
  This study demonstrated that one fourth of the CT scans that were executed were initially negative for leakage. Most patients with a grade C leakage will not have an intact anastomosis. An anastomotic leakage leads to significantly more severe postoperative complications, higher rate of reoperations, and higher mortality. An earlier relaparotomy instead of a CT scan and improved postoperative surveillance could possibly reduce the consequences of the anastomotic leakage.
authors.affiliation: Department of Surgery, Scandinavian Surgical Outcomes Research Group (SSORG), Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital/Östra, SE-416 85, Gothenburg, Sweden. bodil.gessler@vgregion.se.
authors.forename: Bodil
authors.identifier: http://orcid.org/0000-0002-0561-4672
authors.initials: B
authors.lastname: Gessler
authors.affiliation: Department of Surgery, Scandinavian Surgical Outcomes Research Group (SSORG), Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital/Östra, SE-416 85, Gothenburg, Sweden.
authors.forename: Olle
authors.initials: O
authors.lastname: Eriksson
authors.affiliation: Department of Surgery, Scandinavian Surgical Outcomes Research Group (SSORG), Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital/Östra, SE-416 85, Gothenburg, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Angenete
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000175:diagnosis* / Q000209:etiology*; D003107:Colorectal Surgery / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D009017:Morbidity; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012086:Reoperation
keywords: Anastomotic leakage; Colrectal surgery; Postoperative complications