[Influential factors in anastomosis healing]

Anastomotic leakage after visceral surgery is one of the most important and feared complication. According to the literature the rate of clinically apparent anastomotic leakage ranges from 3.4% to as high as 12% and at least one third of the mortality after colorectal surgery is attributed to leaks at the anastomotic site. Within this context, knowledge of factors influencing anastomotic healing appears even more important. Beside surgical-technical (suture technique, suture material) and surgical-tactical factors (primary anastomosis vs. discontinuity resection or formation of protective diverting stomas) knowledge of the various endogenous (diabetes, sepsis, infection, malnutrition) and exogenous factors (steroids, radiation, preoperative bowel preparation) influencing anastomotic healing is essential. Recently, it has been demonstrated that Mycophenolate mofetil, an immunosuppressive drug that is currently used in transplantation and in chronic inflammatory diseases significantly impairs mechanical stability of the healing anastomosis. In contrary, local application of keratinocyte growth factor (KGF) as well as insulin-like growth factor-I (IGF-I) have been shown to accelerate and improve anastomotic healing and mechanical stability in an animal model. Studies that will identify further factors and drugs influencing anastomotic healing are of great importance since the use of such drugs could have enormous clinical implications. The traditional use of temporary diverting stomas following operations such as coloanal anastomosis or ileopouch anastomosis as well as Hartmann's discontinuity resection could be eliminated even in immunocompromised or other high risk patients.