Our Summary

This research paper discusses the issues around anastomotic leakage (AL) - a complication from surgery on the intestines where the area that was sewn back together (the anastomosis) leaks. AL is a big problem for colorectal surgery, but it’s not well defined or consistently reported in studies, and its long-term effects on patients and healthcare resources have been largely ignored. There’s ongoing debate about how best to prevent it. Current tests to diagnose it often miss it or diagnose it too late, leading to more health problems for the patients. New techniques like using a special dye that shows up under a certain type of light (fluorescence angiography) during surgery are being explored to help surgeons see in real time if the anastomosis is good and might reduce AL rates. Also, new ideas are coming up about the role of the bacteria in the lining of the rectum in AL and potential preventative treatments. In 2016, a group of expert surgeons and pathologists met in London to discuss the challenges around AL in colorectal surgery and came up with a list of research areas that need to be addressed.

FAQs

  1. What is anastomotic leakage (AL) and why does it present a challenge in colorectal surgery?
  2. What is the role of intra-operative fluorescence angiography in colorectal surgery?
  3. How does the rectal mucosal microbiome potentially influence anastomotic leakage?

Doctor’s Tip

One helpful tip a doctor might give a patient about colorectal surgery is to follow all pre-operative instructions provided by the medical team, such as fasting before surgery and taking prescribed medications as directed. Additionally, it is important to discuss any concerns or questions with the surgeon before the procedure to ensure optimal outcomes. Following a healthy diet and maintaining good bowel habits both before and after surgery can also help promote healing and reduce the risk of complications. Finally, attending all follow-up appointments and adhering to post-operative care instructions are crucial for successful recovery.

Suitable For

Patients who may be recommended for colorectal surgery include those with:

  • Colorectal cancer
  • Inflammatory bowel disease (such as Crohn’s disease or ulcerative colitis)
  • Diverticulitis
  • Benign colorectal tumors
  • Fecal incontinence
  • Rectal prolapse

It is important to note that each patient’s case is unique and the decision for surgery should be made in consultation with a colorectal surgeon after a thorough evaluation of the patient’s condition.

Timeline

Before colorectal surgery:

  • Patient undergoes initial consultation with a colorectal surgeon to discuss the need for surgery
  • Patient undergoes pre-operative testing and preparation, which may include blood tests, imaging studies, and bowel preparation
  • Patient receives instructions on how to prepare for surgery, including fasting and medications to stop taking before the procedure

After colorectal surgery:

  • Patient is monitored closely in the recovery room for any signs of complications
  • Patient is started on a clear liquid diet and gradually advanced to solid foods as tolerated
  • Patient may experience pain, swelling, and discomfort at the surgical site
  • Patient is encouraged to walk and perform breathing exercises to prevent complications such as blood clots and pneumonia
  • Patient is discharged from the hospital once they are stable and able to care for themselves at home
  • Patient follows up with their surgeon for post-operative appointments to monitor their recovery and address any concerns or complications.

What to Ask Your Doctor

  1. What is the specific reason for recommending colorectal surgery?
  2. What are the potential risks and complications associated with the surgery, including the risk of anastomotic leakage?
  3. How can I prepare for the surgery, both physically and mentally?
  4. What is the expected recovery time and what kind of post-operative care will be needed?
  5. How will the success of the surgery be evaluated, and what are the potential long-term outcomes?
  6. Are there any alternative treatment options available for my condition?
  7. What is the experience and success rate of the surgical team in performing colorectal surgeries?
  8. What steps will be taken during the surgery to reduce the risk of anastomotic leakage?
  9. How will any potential signs of anastomotic leakage be monitored and addressed after the surgery?
  10. Are there any specific lifestyle changes or follow-up appointments that will be necessary after the surgery?

Reference

Authors: Vallance A, Wexner S, Berho M, Cahill R, Coleman M, Haboubi N, Heald RJ, Kennedy RH, Moran B, Mortensen N, Motson RW, Novell R, O’Connell PR, Ris F, Rockall T, Senapati A, Windsor A, Jayne DG. Journal: Colorectal Dis. 2017 Jan;19(1):O1-O12. doi: 10.1111/codi.13534. PMID: 27671222