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How to reduce anastomotic leakage in colorectal surgery—report from German expert meeting

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Abstract

Aims

Anastomotic leakage is one of the most worrisome complications in colorectal surgery. An expert meeting was organized to discuss and find a consensus on various aspects of the surgical management of colorectal disease with a possible impact on anastomotic leakage.

Methods

A three-step Delphi-method was used to find consensus recommendations.

Results

Strong consensus was achieved for the use of mechanical bowel preparation and oral antibiotics prior to colorectal resections, the abundance of non-selective NSAIDs, the preoperative treatment of severe iron deficiency anemia, and for attempting to improve the patients’ general performance in the case of frailty. Concerning technical aspects of rectal resection, there was a strong consensus in regard to routinely mobilizing the splenic flexure, to dividing the inferior mesenteric vein, and to using air leak tests to check anastomotic integrity. There was also a strong consensus on not to oversew the stapled anastomoses routinely, to use protective ileostomies for low rectal and intersphincteric, but not for high-rectal anastomoses. Furthermore, a consensus was reached in regard to using CT-scans with rectal contrast enema to evaluate suspected anastomotic leakage as well as measuring C-reactive protein routinely to monitor the postoperative course after colorectal resections. No consensus was found concerning the indication and technique for testing bowel perfusion, the routine use of endoscopy to check the integrity of the anastomosis, the placement of transanal drains for rectal anastomoses and the management of anastomotic leakage with peritonitis.

Conclusion

Consensus could be found for several practice details in the perioperative management in colorectal surgery that might have an influence on anastomotic leakage.

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Acknowledgments

We thank all participants of the Delphi process and consensus conference for their contributions and Dr. Marc Immenroth for his support on data processing and statistical evaluation. Finally, we thank Hartmut Werlich from Johnson&Johnson for his significant support in organizing all steps of the Delphi process and for organizing the consensus meeting.

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Authors and Affiliations

  1. Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Klinikum Leverkusen gGmbH, Am Gesundheitspark 11, 51375, Leverkusen, Germany

    Andreas D. Rink

  2. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany

    Andreas D. Rink

  3. Klinik für Allgemein- und Viszeralchirurgie, Theresienkrankenhaus und St. Hedwig-Klinik GmbH, Mannheim, Germany

    Peter Kienle

  4. Chirurgische Klinik Campus Charité Mitte/Campus Virchow, Charité–Universitätsmedizin Berlin, Berlin, Germany

    Felix Aigner

  5. Chirurgische Klinik I, Rheinland Klinikum GmbH, Lukaskrankenhaus Neuss, Neuss, Germany

    Alexis Ulrich

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  1. Andreas D. Rink
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Correspondence to Andreas D. Rink.

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Rink, A.D., Kienle, P., Aigner, F. et al. How to reduce anastomotic leakage in colorectal surgery—report from German expert meeting. Langenbecks Arch Surg 405, 223–232 (2020). https://doi.org/10.1007/s00423-020-01864-5

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  • DOI: https://doi.org/10.1007/s00423-020-01864-5

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