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Anastomotic leak in colorectal surgery: a review

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Author(s): Rahila Essani | Roberto Bergamaschi

Journal: Polish Gastroenterology
ISSN 1232-9886

Volume: 16;
Issue: 2;
Start page: 123;
Date: 2009;
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Keywords: anastomotic leak | colorectal surgery | risk factors | surgical rituals | mortality

ABSTRACT
Anastomotic leak is a major complication of colorectal surgery, leading to significant morbidity and mortality. This article focuses on defi-nitions of anastomotic and subclinical leaks, risk factors associated with anastomotic leaks, relevance of surgical rituals, and use of imaging studies in diagnosing leaks. Surgeon skill is one of the most important determinants of clinical anastomotic leakage after colorectal surgery. Other factors known to affect anastomotic healing include: blood supply, steroids, contaminated wound, and nutrition. Although a surgeon makes a decision about technique or a clinical judgment based largely upon personal preference and perception of a particular advantage, surgical rituals such as handsewn vs. stapled anastomois, use of pelvic drains, creation of defunctioning ileostomy are reviewed based on the literature available. Computed tomography (CT) imaging has been reported to be effective in identifying patients with anastomotic leaks and can detect intra-abdominal and perianastomotic abscesses, which can mimic the signs and symptoms of an anastomotic leak. However, water-soluble contrast enema seems superior to CTfor diagnosis of anastomotic leak.

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