Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Aug 31, 2019; 7(8): 389-398
Published online Aug 31, 2019. doi: 10.13105/wjma.v7.i8.389
Preventive strategies for anastomotic leakage after colorectal resections: A review
Mostafa Shalaby, Waleed Thabet, Mosaad Morshed, Mohamed Farid, Pierpaolo Sileri
Mostafa Shalaby, Waleed Thabet, Mosaad Morshed, Mohamed Farid, Department of General Surgery, Mansoura University Hospitals, Mansoura University, Dakahliya, Mansoura 35516, Egypt
Mostafa Shalaby, Pierpaolo Sileri, Department of General Surgery UOC C, Policlinico Tor Vergata Hospital, University of Rome Tor Vergata, Rome 00133, Italy
Author contributions: All authors fulfill the authorship characters proposed by the ICMJE.
Conflict-of-interest statement: all authors have nothing to disclose.
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:
Corresponding author: Mostafa Shalaby, MBChB, MD, MSc, PhD, Lecturer, Surgeon, Department of General Surgery, Mansoura University Hospitals, Mansoura University, 60 Elgomhouria Street, Dakahliya, Mansoura 35516, Egypt.
Telephone: +20-100-1645917
Received: August 9, 2019
Peer-review started: August 9, 2019
First decision: August 20, 2019
Revised: August 31, 2019
Accepted: August 31, 2019
Article in press: August 31, 2019
Published online: August 31, 2019
Core Tip

Core tip: Although the most important prerequisites for the creation of anastomosis is well-perfused and tension-free anastomosis, surgeons have proposed several preventive measures, which were assumed to reduce the incidence of anastomotic leakage, including antibiotic prophylaxis, intraoperative air leak test, omental pedicle flap, defunctioning stoma, pelvic drain insertion, stapled anastomosis, and general surgical technique. However, the decision remains based on the surgeon’s choice. This review found that many preventative measures were employed with no clear evidence supporting the superiority of stapled anastomosis over hand-Sewn anastomosis, coating of the anastomosis, or pelvic drain. Defunctioning stoma, when justified it could decrease the leakage-related complications and the incidence of reoperation. Mechanical bowel preparation combined with oral antibiotics still recommended.