How to Prevent Anastomotic Leak in Colorectal Surgery? A Systematic Review

Anastomosis leakage (AL) after colorectal surgery is an embarrassing problem. It is associated with poor consequence. This review aims to summarize published evidence on prevention of AL after colorectal surgery and provide recommendations according to the Oxford Centre for Evidence-Based Medicine. We conducted bibliographic research on January 15, 2020, of PubMed, Cochrane Library, Embase, Scopus, and Google Scholar. We retained meta-analysis, reviews, and randomized clinical trials. We concluded that mechanical bowel preparation did not reduce AL. It seems that oral antibiotic or oral antibiotic with mechanical bowel preparation could reduce the risk of AL. The surgical approach did not affect the AL rate. The low ligation of the inferior mesenteric artery could reduce the AL rate. The mechanical anastomosis is superior to handsewn anastomosis only in case of right colectomies, with similar results in rectal surgery between the 2 anastomosis techniques. In the case of right colectomies, this anastomosis could be performed intracorporeally or extracorporeally with similar outcomes. The air leak test did not reduce AL. There is no interest of external drainage in colonic surgery but drains reduced the rate of AL and rate of reoperation after low anterior resection. The transanal tube reduced the rate of AL.

[Pancreatic pseudocysts complicated by hemorrhage and infection]

The occurrence of bleeding complications secondary to the development of pancreatic pseudocysts is rare but associated with high mortality. To report a case of pancreatic pseudocyst complicated by hemorrhage and infection A 62 years old patient with history of severe acute pancreatitis two months ago consulted for abdominal pain associate with fever and internal bleeding. CT scan showed a heterogeneous PK complicated by hematoma of the ACE and hemoperitoneum. The emergency surgical treatment showed a PK superinfected with erosion of the splenic artery. It was directed by a left splenopancreatectomy Therapeutic management of hemorrhagic complications of pancreatic pseudo cysts is surgery despite the contribution of art‚rio-embolisation