Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2016; 22(32): 7226-7235
Published online Aug 28, 2016. doi: 10.3748/wjg.v22.i32.7226
Integrated approach to colorectal anastomotic leakage: Communication, infection and healing disturbances
Cloë L Sparreboom, Zhou-Qiao Wu, Jia-Fu Ji, Johan F Lange
Cloë L Sparreboom, Johan F Lange, Department of Surgery, Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands
Zhou-Qiao Wu, Jia-Fu Ji, Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Haidian District, Beijing 100142, China
Author contributions: Wu ZQ and Ji JF structured this review; Sparreboom CL and Wu ZQ drafted the manuscript, which was further critically revised by all authors.
Conflict-of-interest statement: Authors declare no conflict of interest for this article.
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: Zhou-Qiao Wu, MD, PhD, Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, No. 52 Fu-Cheng Road, Haidian District, Beijing 100142, China.
Telephone: +86-10-88196605 Fax: +86-10-88196652
Received: March 27, 2016
Peer-review started: March 28, 2016
First decision: May 12, 2016
Revised: June 1, 2016
Accepted: June 15, 2016
Article in press: June 15, 2016
Published online: August 28, 2016

Colorectal anastomotic leakage (CAL) remains a major complication after colorectal surgery. Despite all efforts during the last decades, the incidence of CAL has not decreased. In this review, we summarize the available strategies regarding prevention, prediction and intervention of CAL and categorize them into three categories: communication, infection and healing disturbances. These three major factors actively interact during the onset of CAL. We aim to provide an integrated approach to CAL based on its etiology. The intraoperative air leak test, intraoperative endoscopy, radiological examinations and stoma construction mainly aim to detect and to prevent communication between the intra- and extra-luminal content. Other strategies including postoperative drainage, antibiotics, and infectious-parameter evaluation are intended to detect and prevent anastomotic or peritoneal infection. Most currently available interventions for CAL focus on the control of communication and infection, while strategies targeting the healing disturbances such as lifestyle changes, oxygen therapy and evaluation of metabolic biomarkers still lack wide clinical application. This simplified categorization may contribute to an integrated understanding of CAL. We strongly believe that this integrated approach should be taken into consideration during clinical practice. An integrated approach to CAL could contribute to a better understanding of the etiology of CAL and eventually better patient outcome.

Keywords: Colorectal anastomotic leakage, Integrated approach, Prevention, Prediction, Intervention

Core tip: Colorectal anastomotic leakage (CAL) remains the most dangerous complication after colorectal surgery. In this review, we propose an integrated approach for CAL, consisting of three major parts, communication, infection, and healing disturbances. This simplified categorization is based on the etiology of leakage and may contribute to our integrated understanding of CAL, and eventually facilitate an integrated approach to CAL and eventually better patient outcome.