Prevention of Anastomotic Leakage in Gastrointestinal Tract: A Brief Literature Review.

ABSTRACT

Anastomotic leakage and its consequences in gastrointestinal tract surgery, especially in low anterior resection, is a day major complication affecting morbidity and mortality rate. Early detection and prevention is crucial in order for sepsis to be avoided. There are well-defined risk factors influencing anastomosis healing. The patient’s status and operative conditions including surgical technique have been incriminated for dehiscence. The correct application of conventional operative principles is important. The outcome of anastomosis either handsewn or stapled is deemed to have no major difference. Novel compression anastomotic instruments have been proposed as an alternative option, yet without wide broad application and enough experience. There are innovative staple line reinforcement materials. Some topics such as proximal defunctioning stoma, pelvic tubes or the recently proposed transanal drainage tube are in debate for routine or selective use. Protective transverse colostomy does not affect the risk of leakage, but it reduces the septic consequences. Laparoscopic procedures have similar anastomotic leakage rate with open operations. There is no consensus on whether covering anastomosis with great omentum is necessary as protection or for mechanical bowel preparation. Novel promising perspectives exist as well as commonly accepted aspects. The combination of conventional techniques (handsewn or stapled anastomosis performance) with modern techniques may be proved effective in reducing anastomotic leakage rates.