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[Chronic anastomotic leak after low rectal resection-an unsolved problem?]

Peter Kienle1, Jörn Richard Magdeburg2

  • 1Allgemein-und Viszeralchirurgie, Theresienkrankenhaus und St. Hedwig-Klinik gGmbH, Bassermannstraße 1, 68165, Mannheim, Deutschland. p.kienle@theresienkrankenhaus.de.

Der Chirurg; Zeitschrift Fur Alle Gebiete Der Operativen Medizen
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PubMed
Summary

Chronic anastomotic leaks, often presenting as chronic sinus tracts after rectal resection, lack a clear definition but can be managed with various surgical options. Successful treatment rates are generally over 70%, though publication bias may affect real-world outcomes.

Keywords:
Chronic sinusDeroofingRedo anastomosisStoma reversalVacuum treatment

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Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Colorectal Surgery

Background:

  • Chronic anastomotic leaks are a complication following low anterior rectal resection, occurring in 2-16% of patients.
  • These leaks often present as chronic sinus tracts with no universally accepted definition or management guidelines.
  • The heterogeneous presentation complicates the collection of comparable data for treatment efficacy.

Purpose of the Study:

  • To review the various therapeutic options for managing chronic anastomotic leaks.
  • To assess the reported success rates of different treatment modalities.
  • To highlight the challenges in managing these complex cases due to lack of standardized definitions.

Main Methods:

  • Review of existing literature on chronic anastomotic leaks after low anterior rectal resection.
  • Analysis of reported therapeutic strategies including debridement, cavity deroofing, endosponge therapy, stenting, flap repair, fibrin glue, and re-anastomosis.
  • Evaluation of reported healing and success rates.

Main Results:

  • A wide array of therapeutic options are employed, often in combination, tailored to individual patient cases.
  • Reported healing rates in the literature generally exceed 70%.
  • Successful treatment, defined by stoma reversal, is achieved in an estimated 70-85% of patients, though publication bias is a concern.

Conclusions:

  • Management of chronic anastomotic leaks is individualized due to their varied presentation.
  • While reported success rates are high, potential publication bias may overestimate real-world effectiveness.
  • Further standardization in definition and reporting is needed for better comparative analysis.