Our Summary

This research paper looks at the factors that might predict if a patient will need additional surgery due to leakage from a connection point (anastomosis) after a colectomy (removal of part or all of the colon). The authors studied patients from 2007 to 2016 who had this type of leakage after their colectomy.

They found that out of 81 patients who developed this problem, about 60% needed another surgery. This additional surgery often involved removing the problematic connection point. The study found that patients were more likely to need additional surgery if they had more advanced cancer (T stage > 2) and if their original surgery was on the right side of the colon.

The results also showed that the leakage was usually found on the fourth day after surgery and a small portion of patients (about 5%) died. The study also highlighted that having additional surgery due to leakage was associated with more intensive care management and deep abdominal collection (a build-up of fluid in the abdomen).

Most patients (98%) had their stoma (an opening in the abdomen for waste removal) reversed after about four months.

In simple terms, the study suggests that patients who have more advanced colon cancer and surgery on the right side of the colon are more likely to need additional surgery due to leakage after their initial colon removal surgery.

FAQs

  1. What percentage of patients developed anastomotic leakage (AL) after colectomy?
  2. What factors are associated with the need for reoperation due to anastomotic leakage after colectomy?
  3. What procedures were generally involved in reoperation due to anastomotic leakage after colectomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about laparoscopic colectomy is to follow postoperative care instructions carefully to reduce the risk of complications such as anastomotic leakage. This may include maintaining a healthy diet, avoiding heavy lifting, and attending follow-up appointments as scheduled. Additionally, patients should be aware of the signs and symptoms of complications, such as fever, abdominal pain, and changes in bowel habits, and seek medical attention if they occur.

Suitable For

Patients who undergo laparoscopic colectomy for colorectal cancer, particularly those with T stage >2 and those undergoing right-sided colectomy, are at higher risk for developing anastomotic leakage (AL) and may be recommended for reoperation if AL occurs. This study found that patients who required reoperation for AL after colectomy were more likely to have right-sided colectomy and T stage >2 colorectal cancer. Patients with these risk factors may benefit from closer monitoring and early intervention to prevent complications related to AL.

Timeline

  1. Patient undergoes laparoscopic colectomy procedure
  2. Patient is monitored postoperatively for signs of anastomotic leakage
  3. Anastomotic leakage is diagnosed on average on postoperative day 4
  4. Patient may require reoperation if conservative management is not successful
  5. Reoperation may involve anastomosis resection, particularly in cases of right-sided colectomy
  6. Reoperation for anastomotic leakage is associated with increased intensive care management and deep abdominal collection
  7. Risk factors for reoperation include T stage >2 and right-sided colectomy
  8. Stoma reversal is performed in the majority of patients after a median of 4 months post-reoperation.

What to Ask Your Doctor

  1. What is the likelihood of developing anastomotic leakage after laparoscopic colectomy?
  2. How soon after surgery is anastomotic leakage typically diagnosed?
  3. What are the signs and symptoms of anastomotic leakage that I should watch out for?
  4. What factors might increase my risk of needing reoperation for anastomotic leakage?
  5. How is anastomotic leakage typically treated, and what is the success rate of nonoperative management?
  6. If reoperation is necessary, what does the surgical procedure typically involve?
  7. How long does it typically take to recover from reoperation for anastomotic leakage?
  8. Will I need a temporary or permanent stoma after reoperation for anastomotic leakage?
  9. Are there any steps I can take before surgery to reduce my risk of developing anastomotic leakage?
  10. What is the long-term outlook for patients who experience anastomotic leakage after colectomy?

Reference

Authors: Zarzavadjian Le Bian A, Tabchouri N, Denet C, Guilbaud T, Laforest A, Tresallet C, Ferraz JM, Gayet B, Fuks D. Journal: J Laparoendosc Adv Surg Tech A. 2021 Sep;31(9):1040-1045. doi: 10.1089/lap.2020.0765. Epub 2020 Oct 29. PMID: 33121354