Opinion Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 14, 2019; 25(34): 5017-5025
Published online Sep 14, 2019. doi: 10.3748/wjg.v25.i34.5017
Reducing anastomotic leak in colorectal surgery: The old dogmas and the new challenges
Jeremy Meyer, Surennaidoo Naiken, Niki Christou, Emilie Liot, Christian Toso, Nicolas Christian Buchs, Frédéric Ris
Jeremy Meyer, Surennaidoo Naiken, Niki Christou, Emilie Liot, Christian Toso, Nicolas Christian Buchs, Frédéric Ris, Division of Digestive Surgery, University Hospitals of Geneva, Genève 1211, Switzerland
Author contributions: Meyer J conceived the review and wrote the draft of the manuscript; Meyer J, Naiken S, Christou N, Liot E, Toso C, Buchs NC and Ris F reviewed and accepted the manuscript.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Open-Access: This article is an open-access article which was selected byan 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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jeremy Meyer, MD, PhD, Surgeon, Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, Genève 1211, Switzerland. jeremy.meyer@hcuge.ch
Telephone: +41-79-5533182 Fax: +41-22-3727707
Received: March 19, 2019
Peer-review started: March 19, 2019
First decision: August 3, 2019
Revised: August 9, 2019
Accepted: August 19, 2019
Article in press: August 19, 2019
Published online: September 14, 2019
Abstract

Anastomotic leak (AL) constitutes a significant issue in colorectal surgery, and its incidence has remained stable over the last years. The use of intra-abdominal drain or the use of mechanical bowel preparation alone have been proven to be useless in preventing AL and should be abandoned. The role or oral antibiotics preparation regimens should be clarified and compared to other routes of administration, such as the intravenous route or enema. In parallel, preoperative antibiotherapy should aim at targeting collagenase-inducing pathogens, as identified by the microbiome analysis. AL can be further reduced by fluorescence angiography, which leads to significant intraoperative changes in surgical strategies. Implementation of fluorescence angiography should be encouraged. Progress made in AL comprehension and prevention might probably allow reducing the rate of diverting stoma and conduct to a revision of its indications.

Keywords: Anastomotic leakage, Rectal surgery, Colic surgery, Prevention, Surgical site infection, Anastomosis, Complication

Core tip: The present manuscript reviews the current evidence regarding the prevention of anastomotic leak in colorectal surgery. Oral antibiotics and fluorescence angiography might help reduce the incidence of anastomotic leak. Study of the microbiome might offer interesting paths for research. Progress made in anastomotic leak comprehension and prevention might allow reducing the rate of diverting stoma and conduct to a revision of its indications.