Published online Jun 7, 2018. doi: 10.3748/wjg.v24.i21.2247
Peer-review started: April 6, 2018
First decision: April 19, 2018
Revised: May 6, 2018
Accepted: May 18, 2018
Article in press: May 18, 2018
Published online: June 7, 2018
Every colorectal surgeon during his or her career is faced with anastomotic leakage (AL); one of the most dreaded complications following any type of gastrointestinal anastomosis due to increased risk of morbidity, mortality, overall impact on functional and oncologic outcome and drainage on hospital resources. In order to understand and give an overview of the AL risk factors in laparoscopic colorectal surgery, we carried out a careful review of the existing literature on this topic and found several different definitions of AL which leads us to believe that the lack of a consensual, standard definition can partly explain the considerable variations in reported rates of AL in clinical studies. Colorectal leak rates have been found to vary depending on the anatomic location of the anastomosis with reported incidence rates ranging from 0 to 20%, while the laparoscopic approach to colorectal resections has not yet been associated with a significant reduction in AL incidence. As well, numerous risk factors, though identified, lack unanimous recognition amongst researchers. For example, the majority of papers describe the risk factors for left-sided anastomosis, the principal risk being male sex and lower anastomosis, while little data exists defining AL risk factors in a right colectomy. Also, gut microbioma is gaining an emerging role as potential risk factor for leakage.
Core tip: In colorectal surgery, knowledge and prevention of possible complications are mandatory. Anastomotic leakage is a major issue in laparoscopic colorectal surgery and furthermore, its etiology is not fully understood. The aim of this review was to evaluate the current literature to identify patient-related and perioperative risk factors for leakage in patients undergoing colorectal resection by laparoscopy. Full awareness of risk factors is essential for identifying high-risk patients and properly select them for diverting stomas in order to mitigate potential severe clinical consequences of anastomotic leakage.