Factors Contributing to Anastomotic Leakage Following Colorectal Surgery: Why, When, and Who Leaks?

Anastomotic leakage is a common yet one of the most feared complications following colorectal surgery. Dehiscence of the anastomosis can result in fatal complications such as peritonitis, abscess formation, and sepsis, thereby increasing morbidity and mortality, cost and length of hospital stay. Multiple factors contribute to the development of anastomotic dehiscence. Several studies have been published identifying various risk factors that may play a role in causing AL. Our study reviewed prospective and retrospective studies and summarized the risk factors into three categories: preoperative, intraoperative, and postoperative. Among these are various risk factors such as age, gender, comorbidities, American Society of Anesthesiologists (ASA) scores, operative time, smoking, alcohol use, obesity, nutritional status, mechanical bowel preparation, and steroid use. It is crucial for surgeons to have a thorough understanding of the risk factors associated with anastomotic leakage to identify patients at high risk preoperatively. It may also be relevant to intraoperative decision-making when establishing an anastomosis, such as considering proximal diversion or placing a drain if such high-risk features are present. Knowing high-risk features also helps to detect leaks as early as possible postoperatively.