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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 7, 2016; 22(25): 5718-5727
Published online Jul 7, 2016. doi: 10.3748/wjg.v22.i25.5718
Preoperative, intraoperative and postoperative risk factors for anastomotic leakage after laparoscopic low anterior resection with double stapling technique anastomosis
Kenji Kawada, Yoshiharu Sakai
Kenji Kawada, Yoshiharu Sakai, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
Author contributions: Kawada K wrote the paper; Sakai Y contributed critical revision of the manuscript for important intellectual content.
Conflict-of-interest statement: No potential conflicts of interest exist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Kenji Kawada, MD, PhD, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
Telephone: +81-75-3667595 Fax: +81-75-3667642
Received: April 7, 2016
Peer-review started: April 8, 2016
First decision: May 27, 2016
Revised: May 30, 2016
Accepted: June 13, 2016
Article in press: June 13, 2016
Published online: July 7, 2016

Anastomotic leakage (AL) is one of the most devastating complications after rectal cancer surgery. The double stapling technique has greatly facilitated intestinal reconstruction especially for anastomosis after low anterior resection (LAR). Risk factor analyses for AL after open LAR have been widely reported. However, a few studies have analyzed the risk factors for AL after laparoscopic LAR. Laparoscopic rectal surgery provides an excellent operative field in a narrow pelvic space, and enables total mesorectal excision surgery and preservation of the autonomic nervous system with greater precision. However, rectal transection using a laparoscopic linear stapler is relatively difficult compared with open surgery because of the width and limited performance of the linear stapler. Moreover, laparoscopic LAR exhibits a different postoperative course compared with open LAR, which suggests that the risk factors for AL after laparoscopic LAR may also differ from those after open LAR. In this review, we will discuss the risk factors for AL after laparoscopic LAR.

Keywords: Risk factor, Laparoscopic low anterior resection, Anastomotic leakage

Core tip: Recently, many studies have reported that laparoscopic rectal surgery is becoming popular and exhibits favorable outcomes compared with open surgery. However, the anastomotic leakage (AL) rate after laparoscopic low anterior resection (LAR) is yet about 10%, and AL remains a huge challenge despite many surgical and technological advances. Here we review the current literature published with respect to the risk factors for AL after laparoscopic LAR.