A systematic review was conducted to examine evidence on prevention of anastomotic leak after colorectal surgery. PubMed, Cochrane Library, Embase, Scopus and Google Scholar were searched for suitable published literature. Relevant meta-analysis, reviews and randomized clinical trials were included in the review. Controlled clinical trials, case series, case reports and editorial letters were excluded. Fifty-one articles published between 2002 and 2020 were included.

The review examined evidence for laparoscopic approach to conventional approach and found that the surgical approach had no effect on the rate of anastomotic leaks. The impact of the level of vascular ligation was also reviewed. High ligation of the inferior mesenteric artery could adversely affect the integrity of the anastomosis by impinging on the blood flow. Low ligation of the inferior mesenteric artery could prevent anastomotic dehiscence and leakage. Evaluation of the anastomosis techniques revealed that mechanical (stapled) anastomosis was superior to hand-sewn anastomosis only in case of right colectomies; the results in rectal surgery were comparable. In right colectomies, this anastomosis could be performed intracorporeally or extracorporeally with similar outcomes. Intraoperative air leak test to check for the tautness of the anastomosis did not reduce the risk of anastomotic leak. Routine use of drains after colon surgery is no longer necessary, but in patients who underwent anterior resection, drains reduced the rate of postoperative anastomotic leaks. However, the use of transanal tubes reduced the risk of anastomotic leaks in high risk patients. Oral antibiotic or oral antibiotic with mechanical bowel preparation could reduce the risk of leakage.

Anastomotic leakage continues to be a problem after colorectal surgery despite advances in surgical procedures. Recognition of risk factors is an important part of its management. Its prevention is challenging, but it is the best treatment, according to the authors. This review explored several factors implicated in anastomotic leaks, the fact remains that many more potential factors need to be evaluated.

Source: Chaouch MA, et al. Ann Coloproctol. 2020 Aug;36(4):213-222.