Surgical Endoscopy

, Volume 16, Issue 4, pp 603–606 | Cite as

The management of leaking rectal anastomoses by minimally invasive techniques

  • M. Pera
  • S. Delgado
  • J. C. García-Valdecasas
  • M. Pera
  • A. Castells
  • J. M. Piqué
  • E. Bombuy
  • A. M. Lacy
Original Articles



The salvage of a leaking rectal anastomosis has been reported in selected cases. Herein we present our experience in the management of rectal anastomotic dehiscence by minimally invasive techniques.


A total of 94 patients underwent anterior rectal resection for rectal cancer in an 18-month period. The operation was laparoscopic-assisted in 76 cases (81%).


Clinical anastomotic dehiscences occurred in 10 cases (10.6%). Conservative therapy, including the percutaneous drainage of pelvic abscesses, was successful in three cases. Among the seven patients who required reoperation, the anastomosis was taken down in only one case. In four of these cases, the reoperation was performed laparoscopically, including peritoneal lavage and the creation of a diverting stoma. There were no complications resulting from the use of laparoscopy in the early postoperative period. Closure of the stoma was possible in eight patients.


The salvage of a leaking rectal anastomosis is feasible in the vast majority of these cases (80%). The combination of laparoscopy and interventional radiology is a good alternative to laparotomy in patients who have had previous laparoscopic rectal excision.

Key words

Rectal cancer Anastomotic leakage Laparoscopy Interventional radiology Cancer 


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  1. 1.
    Balague C, Targarona E, Pujol M, Filella X, Espert J, Trias M (1999) Peritoneal response to a septic challenge: Comparison between open laparotomy, pneumoperitoneum laparoscopy, and wall lift laparoscopy. Surg Endosc 13: 792–796CrossRefPubMedGoogle Scholar
  2. 2.
    Carlsen E, Schlichting E, Guldvog I, Johnson E, Heald R (1998) Effect of the introduction of the total mesorectal excision for the treatment of rectal cancer. Br J Surg 85: 526–529CrossRefPubMedGoogle Scholar
  3. 3.
    Cueto J, Diaz O, Garteiz D, Rodriguez M, Weber A (1997) The efficacy of laparoscopic surgery in the diagnosis and treatment of peritonitis: experience with 107 cases in Mexico City. Surg Endosc 11: 366–370CrossRefPubMedGoogle Scholar
  4. 4.
    Dehni N, Schlegel R, Cunningham C, Guiguet M, Tiret E, Parc R (1998) Influence of a defunctioning stoma on leakage rates after low colorectal anastomosis and colonic J-pouch-anal anastomosis. Br J Surg 85: 1114–1117CrossRefPubMedGoogle Scholar
  5. 5.
    Geis WP, Kim H (1995) Use of laparoscopy in the diagnosis and treatment of patients with surgical abdominal sepsis. Surg Endosc 9: 178–182CrossRefPubMedGoogle Scholar
  6. 6.
    Hallböök O, Sjodahl R (1996) Anastomotic leakage and functional outcome after anterior resection of the rectum. Br J Surg 83: 60–62CrossRefPubMedGoogle Scholar
  7. 7.
    Ichihara T, Nagahata Y, Nomura H, Fukumoto S, Urakawa T, Aoyama N, Kuroda Y (2000) Laparoscopic lower anterior resection is equivalent to laparotomy for lower rectal cancer at the distal line of resection. Am J Surg 179: 97–98CrossRefPubMedGoogle Scholar
  8. 8.
    Karanjia N, Corder A, Beam P, Heald R (1994) Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum. Br J Surg 81: 1224–1226CrossRefPubMedGoogle Scholar
  9. 9.
    Kockerling F, Rose J, Schneider C, Scheidbach H, Scheuerlein H, Reymond M, Rech T, Konradt J, Bruch H, Zornig C, et al. (1999) Laparoscopic colorectal anastomosis: risk of postoperative leakage. Surg Endosc 13: 639–644CrossRefPubMedGoogle Scholar
  10. 10.
    Kohler A, Athanasiadis S, Ommer A, Psarakis E (2000) Long-term results of low anterior resection with intersphincteric anastomosis in carcinoma of the lower one-third of the rectum: analysis of 31 patients. Dis Col Rectum 43: 843–850CrossRefGoogle Scholar
  11. 11.
    Lacy A, Garcia-Valdecasas J, Delgado S, Grande L, Fuster J, Tabet J, Ramos C, Pique J, Cifuentes A, Visa J (1997) Postoperative complications of laparoscopic-assisted colectomy. Surg Endosc 11: 119–122CrossRefPubMedGoogle Scholar
  12. 12.
    Lau J, Lo S, Ng E, Lee D, Lam Y, Chung S (1998) A randomized comparison of acute phase response and endotoxemia in patients with perforated peptic ulcers receiving laparoscopic or open patch repair. Am J Surg 175: 325–327CrossRefPubMedGoogle Scholar
  13. 13.
    Law W, Chu K, Ho J, Chan CW (2000) Risk factors for anastomotic leakage after low anterior resection with total mesorectal excision. Am J Surg 179: 92–96CrossRefPubMedGoogle Scholar
  14. 14.
    Moran B, Heald R (2001) Risk factors for, and management of anastomotic leakage in rectal surgery. Colorectal Dis 3: 135–137CrossRefPubMedGoogle Scholar
  15. 15.
    Nesbakken A, Nygaard K, Lunde O (2001) Outcome and late functional results after anastomotic leakage following mesorectal excision for rectal cancer. Br J Surg 88: 400–404CrossRefPubMedGoogle Scholar
  16. 16.
    Perling DC, Needlman L, Eschelman DJ, Hovsepian DM, Lev-Toaff AS (1998) Deep pelvic abscesses: transperineal US-guided drainage. Radiology 208: 111–115CrossRefGoogle Scholar
  17. 17.
    Rullier E, Laurent C, Garrelon J, Michel P, Saric J, Parneix M (1988) Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 85: 335–358Google Scholar
  18. 18.
    Targarona E, Balague C, Knook M, Trias M (2000) Laparoscopic surgery and surgical infection. Br J Surg 87: 536–544CrossRefPubMedGoogle Scholar
  19. 19.
    Tug T, Ozbas S, Tekeli A, Gundogdu H, Doseyen Z, Kuzu I (1988) Does pneumoperitoneum cause bacterial translocation? J Laparoendosc Adv Surg Tech A 8: 401–407CrossRefGoogle Scholar
  20. 20.
    Vignali A, Fazio V, Lavery I, Milsom J, Church J, Hull T, Strong S, Oakley J (1997) Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1,014 patients. J Am Coll Surg 185: 105–113CrossRefPubMedGoogle Scholar
  21. 21.
    Watson A, Krukowski Z, Munro A (1999) Salvage of large bowel anastomotic leaks. Br J Surg 86: 499–500CrossRefPubMedGoogle Scholar
  22. 22.
    Wheeler J, Gilbert J (1999) Controlled intraoperative water testing of left-sided colorectal anastomoses: are ileostomies avoidable? Ann R Coll Surg Engl 81: 105–108PubMedPubMedCentralGoogle Scholar
  23. 23.
    Wills V, Jorgensen J, Hunt D (2000) Role of relaparoscopy in the management of minor leakage after laparoscopic cholecystectomy. Br J Surg 87: 176–180CrossRefPubMedGoogle Scholar
  24. 24.
    Zaheer S, Pemberton J, Farouk R, Dozois R, Wolff B, Ilstrup D (1998) Surgical treatment of adenocarcinoma of the rectum. Ann Surg 227: 800–811CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2002

Authors and Affiliations

  • M. Pera
    • 1
  • S. Delgado
    • 1
  • J. C. García-Valdecasas
    • 1
  • M. Pera
    • 1
  • A. Castells
    • 1
  • J. M. Piqué
    • 1
  • E. Bombuy
    • 1
  • A. M. Lacy
    • 1
  1. 1.Department of Gastrointestinal Surgery, Institute of Digestive DiseasesHospital Clinic of BarcelonaBarcelonaSpain

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