Our Summary

This research paper discusses a common issue that colorectal surgeons face known as anastomotic leakage (AL), a serious complication that can occur after a surgery involving the digestive system. This complication can increase the risk of other health problems, death, and impact the success of the surgery while also using up hospital resources.

The researchers reviewed existing studies on this topic and found that there isn’t a standard definition for AL, which might explain why the reported rates of AL vary so much in different studies. They found that the rates can range from 0 to 20% depending on where in the digestive system the surgery was performed.

They also found that using a laparoscopic approach (a type of minimally invasive surgery) in colorectal surgeries doesn’t necessarily reduce the risk of AL. There are many identified risk factors, but there isn’t agreement among researchers about these. For example, the risk factors for AL in surgeries on the left side of the colon are well-documented, with being male and having the surgery lower in the colon being the main risks. However, there isn’t much data on the risk factors for surgeries on the right side of the colon.

Finally, the researchers mention that the gut microbiome (the community of microorganisms living in our intestines) could potentially be a risk factor for AL, but more research is needed in this area.

FAQs

  1. What is anastomotic leakage (AL) and why is it a major concern in colorectal surgery?
  2. What factors increase the risk of anastomotic leakage in laparoscopic colorectal surgery?
  3. Is there a significant reduction in AL incidence with the laparoscopic approach to colorectal resections?

Doctor’s Tip

One helpful tip a doctor might tell a patient about colorectal surgery is to follow all post-operative care instructions closely, including proper wound care, diet restrictions, and activity limitations. It is important to attend all follow-up appointments and inform your doctor of any unusual symptoms or signs of infection. Additionally, maintaining a healthy lifestyle with a balanced diet and regular exercise can help promote healing and reduce the risk of complications.

Suitable For

Patients who are typically recommended for colorectal surgery include those with:

  1. Colorectal cancer
  2. Inflammatory bowel disease (such as Crohn’s disease or ulcerative colitis)
  3. Diverticulitis
  4. Colorectal polyps
  5. Rectal prolapse
  6. Fecal incontinence

These patients may require surgery for various reasons, such as tumor removal, stricture repair, or management of complications related to their underlying condition. Colorectal surgery may be recommended as a curative or palliative treatment option, depending on the specific circumstances of the patient’s case.

Timeline

Before colorectal surgery:

  1. Patient undergoes preoperative evaluation to assess overall health and suitability for surgery.
  2. Patient may undergo bowel preparation to empty the colon before surgery.
  3. Patient is informed about the procedure, risks, and expected outcomes.
  4. Surgery is scheduled and patient may need to adhere to preoperative fasting instructions.

After colorectal surgery:

  1. Patient is closely monitored in the postoperative recovery area for any immediate complications.
  2. Patient may experience pain, discomfort, and limited mobility following surgery.
  3. Patient is gradually advanced to a clear liquid diet and then to solid foods as tolerated.
  4. Patient may need to wear a colostomy bag or have a temporary diverting stoma to allow the anastomosis to heal.
  5. Patient undergoes follow-up appointments to monitor healing, assess for any complications, and discuss long-term care and surveillance.
  6. Patient may need additional treatments, such as chemotherapy or radiation, depending on the underlying condition (e.g. rectal cancer).
  7. Patient is advised on lifestyle modifications, such as dietary changes and physical activity, to promote recovery and overall health.

What to Ask Your Doctor

  1. What is the risk of anastomotic leakage following colorectal surgery, and how can it be minimized?

  2. Are there specific risk factors that apply to my individual case that could increase the likelihood of anastomotic leakage?

  3. What steps will be taken during the surgery to ensure a successful anastomosis and reduce the risk of complications?

  4. Will I require a diverting stoma to prevent or manage anastomotic leakage, and if so, for how long?

  5. What symptoms should I watch for after surgery that may indicate anastomotic leakage, and when should I seek medical attention?

  6. How will anastomotic leakage be diagnosed and treated if it does occur post-operatively?

  7. Are there any lifestyle changes or precautions I should take after surgery to reduce the risk of anastomotic leakage?

  8. What is the typical recovery time following colorectal surgery, and how will anastomotic leakage impact my recovery process?

  9. Are there any specific follow-up appointments or tests I should have to monitor for potential complications, including anastomotic leakage?

  10. Are there any alternative treatment options or surgical techniques that may reduce the risk of anastomotic leakage in my case?

Reference

Authors: Sciuto A, Merola G, De Palma GD, Sodo M, Pirozzi F, Bracale UM, Bracale U. Journal: World J Gastroenterol. 2018 Jun 7;24(21):2247-2260. doi: 10.3748/wjg.v24.i21.2247. PMID: 29881234