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Related Experiment Video

Updated: Mar 12, 2026

Endoscopic Vacuum Therapy for the Treatment of Anastomotic Leakage after Total Gastrectomy with Esophagojejunostomy
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Chronic Anastomotic Leaks After Low Anterior Resection: Rethinking Evaluation and Management.

Megan E Boyer1, Bailey K Hilty Chu1, Anthony Loria1

  • 1Department of Surgery, Surgical Health Outcomes Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, NY, USA.

The American Surgeon
|March 10, 2026
PubMed
Summary
This summary is machine-generated.

Managing chronic anastomotic leaks after low anterior resection (LAR) with primary anastomosis and diverting loop ileostomy (DLI) is complex. Individualized, patient-centered care is crucial, as structural assessments alone have limited predictive value for stoma reversal success.

Keywords:
chronic anastomotic leakdiverting loop ileostomyrectal cancerstoma reversal

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Area of Science:

  • Colorectal Surgery
  • Surgical Oncology
  • Gastroenterology

Background:

  • Chronic anastomotic leaks post-low anterior resection (LAR) with primary anastomosis and diverting loop ileostomy (DLI) present significant management challenges.
  • Optimal strategies for evaluating and managing these leaks, especially concerning stoma reversal timing and safety, are not well-defined.

Purpose of the Study:

  • To analyze the management patterns, evaluation methods, and outcomes of chronic anastomotic leaks following LAR with DLI.
  • To investigate factors influencing clinical disposition, including stoma reversal, in patients with chronic leaks.

Main Methods:

  • Retrospective study of patients with stage I-III rectal cancer undergoing LAR with DLI and developing chronic anastomotic leaks (defect >30 days).
  • Data abstracted on demographics, procedures, imaging (CT, Gastrografin enemas), endoscopy, and clinical outcomes.
  • Analysis of time to clinical disposition (stoma reversal, permanent ostomy, or DLI maintenance).

Main Results:

  • Nineteen patients met inclusion criteria; 68.4% had percutaneous drainage guided by CT.
  • Imaging and endoscopic assessments showed limited predictive value for reversal success.
  • Median time to disposition was 367 days; 36.8% of attempted reversals achieved durable bowel continuity.

Conclusions:

  • Management of chronic anastomotic leaks is highly individualized, influenced by imaging, patient preference, and surgeon judgment.
  • Relying solely on structural assessments is insufficient; integrated, patient-centered frameworks are needed for evidence-based reversal decisions.