Published online Sep 14, 2019. doi: 10.3748/wjg.v25.i34.5017
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
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.
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.