Laparoscopic Management of Grade C Anastomotic Leak following Left-Sided Colorectal Resection

Management of left-sided colorectal Grade C anastomotic leak (AL) has traditionally been managed via laparotomy. However, with the growing adoption of minimally invasive techniques, recent literature suggests that laparoscopic surgery provides a safe and viable alternative for managing Grade C leaks.

This study is a case series that consists of 7 adults that underwent laparoscopic reintervention of purulent or feculent peritonitis from left-sided colorectal AL during the period of 2016-2024 at our institution. Outcomes measured included days to presentation, operative times, hospital stay, morbidity, mortality, and rates of stoma closure.

Of the 7 patients, 6 of them had purulent peritonitis and one had feculent peritonitis. The average time from index operation to clinically evident AL was 6 days. The patients were managed with laparoscopic with drainage, colorrhapy and Hartmann's procedure.Complications include subhepatic fluid collection, hematoma, infected seroma. The average operative time was 145.3 min. The average length of hospital stay (LOS) after reoperation was 11 days. All patients had their stoma reversed within an average of 90 days. No deaths occurred.

MIS approach to Grade C AL in left-sided colorectal resection is safe and feasible. It can be performed with low morbidity and mortality and high rates of stoma closure.