Minimizing Colorectal Anastomotic Leaks: Best Practices to Assess the Integrity and Perfusion of Left-Sided Anastomoses
Anastomotic leak is an uncommon but a serious complication of any gastrointestinal operation. This complication can result in significant perioperative morbidity and prolonged recovery. In addition, leaks can delay necessary systemic treatment for cancer patients or require reoperations with additional morbidity. Careful attention to anastomotic technique and evaluation of the anastomoses can reduce the risk of leak. Assessment of factors that affect anastomotic integrity includes evaluation of perfusion and tension. These factors can be evaluated, in part, through evaluation of the anastomotic mucosa via endoscopy. In addition to visual inspection, assessment of perfusion with fluorescent angiography is an area of active development that may reduce leak rates. Understanding the tools used to evaluate anastomoses is important for any surgeon operating on the gastrointestinal tract, and therefore proficiency in endoscopic evaluation must be mandated.
KeywordsAnastomosis Colorectal surgery Anastomotic leak Bowel perfusion Endoscopy
The authors are indebted to Abhineet Uppal, MD, for his invaluable contributions to this chapter.
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