• anastomotic leakage
• colonoscopy
• colorectal cancer surgery
• intestinal obstruction catheter
• intestinal stent

• Anastomotic leakage
• Closure
• Double-lumen irrigation-suction tube
• Rectal cancer surgery
• Retrospective cohort study

Anastomotic leakage (AL) is the most serious postoperative complication following anterior resection for rectal cancer. We aimed to investigate the efficacy of active drainage for the management of AL.

This was a retrospective study using information from a database of patients who underwent colorectal resection without a defunctioning ileostomy at our center between September 2013 and January 2021. We identified 122 cases with definitive AL who did not require revision emergent laparotomy. Among these patients, we evaluated those who received active drainage to replace the original passive drainage.

There were 62 cases in the active drainage group and 60 cases in the passive drainage group. The active drainage group had a shorter mean AL spontaneous resolution time (26.9 ± 3.3 vs. 32.2 ± 4.8 days) and lower average hospitalization costs (82,680.6 vs. 92,299.3 renminbi (RMB)) compared with the passive drainage group, respectively. Moreover, seven patients in the passive drainage group subsequently underwent diverting stoma to resolve the Al, while all ALs resolved spontaneously after replacing the passive drainage with active drainage.

Our study suggests that active drainage may accelerate the spontaneous resolution of AL.

• Active drain
• anastomotic leakage
• hospitalization cost
• management
• passive drain
• rectal cancer

• anastomotic leak
• colorectal surgery
• endosponge
• postoperative complication
• rectal cancer

• anastomotic leak
• colorectal surgery
• colostomy
• endoscopy
• ileostomy

• Anastomotic leak
• Anastomotic stricture
• Colorectal surgery
• Urinary retention

• Anastomotic leak
• Colorectal surgery
• Risk factors
• Surgical stoma

Anastomotic leakage is a serious, sometimes critical complication of upper gastrointestinal (GI) surgery. The cavity and target drainage tubes are difficult to reach; therefore, a nasogastric tube (NGT) and fasting are required for an extended period. We successfully treated and managed two patients with anastomotic leakage using percutaneous transesophageal gastro-tubing (PTEG).

In case 1, a 79-year-old man with gastric cancer underwent total gastrectomy; 1 week later, he underwent emergent open laparotomy due to panperitonitis attributed to anastomotic leakage-related jejunojejunostomy. We resected the portion between esophagojejunostomy and jejunojejunostomy and reconstructed it using the Roux-en-Y technique. On postoperative day (POD) 9, anastomotic leakage was diagnosed at the esophagojejunostomy site and jejunotomy staple line. After using a circular stapler for jejunojejunostomy, a stapled jejunal closure was added. We inserted an NGT and performed aspiration for bowel decompression. As he did not improve within 2 weeks, we decided to perform PTEG to free him of the NGT. We kept performing intermittent aspiration; leakage stopped shortly after, due to effective inner drainage. The PTEG catheter was removed after oral intake was restarted. In case 2, an 81-year-old man with esophagogastric junction cancer underwent resection of the distal esophagus and proximal stomach. After shaping the remnant stomach, esophagogastrostomy was performed under the right thoracotomy. On POD 11, anastomotic leakage was identified, along with a mediastinal abscess. We inserted an NGT into the abscess cavity through the anastomotic leakage site. On POD 25, we performed PTEG and inserted a drainage tube, instead of an NGT. Although the abscess cavity disappeared, anastomotic leakage persisted as a fistula. We exchanged the PTEG with a double elementary diet (W-ED) tube with jejunal extension, with the side hole located near the anastomosis. The anastomotic fistula disappeared after treatment. Dysphagia persisted due to disuse atrophy of swallowing musculature; PTEG was useful for enteral feeding, even after the leakage occurred.

Patients are sometimes forced to endure pain for a long time for transnasal inner drainage. Using PTEG, patients will be free of sinus pain and discomfort; PTEG should be helpful for patients withstanding NGT.

• Anastomotic leakage
• Double-lumen feeding tube
• Percutaneous transesophageal gastro-tubing
• Transnasal drainage
• Upper GI surgery

• Anastomotic leak
• Endo-SPONGE
• Endoscopic vacuum-assisted closure
• Rectal neoplasm
• Surgical sponge
• TME

• Anastomotic leakage
• Drainage
• Incidence
• Sigmoid colon cancer

• Double stapling technique
• Laparoscopic low anterior resection
• Transanal drainage tube
• anastomotic leakage
• rectal cancer

• Rectal cancer
• anastomotic leak
• interventional radiology
• minimally invasive
• surgery

• Anastomotic leak (AL)
• leaks
• management
• rectal surgery

We evaluate the role of transanal tube drainage (TD) as a conservative treatment for patients with anastomotic leakage (AL).

Patients treated for AL who had undergone a low or an ultralow anterior resection with colorectal or coloanal anastomosis for the treatment of rectal cancer between January 2013 and January 2017 were enrolled in this study. The data were collected prospectively and analyzed retrospectively. The primary outcomes were the diagnosis and the management of AL.

Two hundred thirteen consecutive patients, 122 males and 91 females, were included. The mean age was 66.91 ± 11.15 years, and the median body mass index was 24 kg/m² (range, 20–35 kg/m²). The median tumor distance from the anal verge was 8 cm (range, 4–12 cm). Ninety-three patients (44%) received neoadjuvant therapy for nodal disease and/or locally advanced rectal cancer. Only 13 patients (6%) developed AL. Six patients developed subclinical AL as they had a defunctioning ileostomy at the time of the initial procedure. They were treated conservatively with TD under endoscopic guidance in the endoscopy unit and received intravenous antibiotics. Six weeks after discharge, these 6 patients underwent follow-up flexible sigmoidoscopy which showed a completely healed anastomotic defect with no residual stenosis. Seven patients developed a clinically significant AL and required reoperation with pelvic abscess drainage and Hartmann colostomy formation.

These results suggest that TD for management of patients with AL is safe, cheap, and effective. Salvaging the anastomosis will help decrease the need for Hartmann colostomy formation. Proper patient selection is important.

• Anastomosis
• Anastomotic leakage
• Rectal cancer
• Transanal tube drainage

• Anastomotic leak
• Anterior resection
• Rectal cancer
• Transanal tube

• anastomotic failure
• colorectal surgery
• endoscopic vacuum therapy

• Anastomotic leakage
• Anterior resection
• Transanal drainage tube

• Anastomotic leakage
• Colrectal surgery
• Postoperative complications

Anastomotic leakage (AL) is one of the most devastating complications after rectal cancer surgery. The double stapling technique has greatly facilitated intestinal reconstruction especially for anastomosis after low anterior resection (LAR). Risk factor analyses for AL after open LAR have been widely reported. However, a few studies have analyzed the risk factors for AL after laparoscopic LAR. Laparoscopic rectal surgery provides an excellent operative field in a narrow pelvic space, and enables total mesorectal excision surgery and preservation of the autonomic nervous system with greater precision. However, rectal transection using a laparoscopic linear stapler is relatively difficult compared with open surgery because of the width and limited performance of the linear stapler. Moreover, laparoscopic LAR exhibits a different postoperative course compared with open LAR, which suggests that the risk factors for AL after laparoscopic LAR may also differ from those after open LAR. In this review, we will discuss the risk factors for AL after laparoscopic LAR.

• Risk factor
• Laparoscopic low anterior resection
• Anastomotic leakage

• Anastomosis, Surgical/methods
• Anastomotic Leak/epidemiology
• Anti-Bacterial Agents/therapeutic use
• Blood Loss, Surgical
• Chemoradiotherapy/statistics & numerical data
• Colostomy/statistics & numerical data
• Digestive System Surgical Procedures/methods
• Drainage
• Drug Therapy/statistics & numerical data
• Gastrointestinal Microbiome
• Humans
• Intraoperative Care
• Neoadjuvant Therapy/statistics & numerical data
• Obesity/epidemiology
• Operative Time
• Postoperative Care
• Preoperative Care
• Radiotherapy/statistics & numerical data
• Rectal Neoplasms/pathology
• Rectal Neoplasms/surgery
• Rectum/blood supply
• Rectum/surgery
• Risk Factors
• Sex Factors
• Surgical Stapling/methods
• Tumor Burden

• anastomosis
• leak
• risk factors
• testing

Anastomotic leak continues to be a dreaded complication after colorectal surgery, especially in the low colorectal or coloanal anastomosis. However, there has been no consensus on the management of the low colorectal anastomotic leak. Currently operative procedures are reserved for patients with frank purulent or feculent peritonitis and unstable vital signs, and vary from simple fecal diversion with drainage to resection of the anastomosis and closure of the rectal stump with end colostomy (Hartmann’s procedure). However, if the patient is stable, and the leak is identified days or even weeks postoperatively, less aggressive therapeutic measures may result in healing of the leak and salvage of the anastomosis. Advances in diagnosis and treatment of pelvic collections with percutaneous treatments, and newer methods of endoscopic therapies for the acutely leaking anastomosis, such as use of the endosponge, stents or clips, have greatly reduced the need for surgical intervention in selected cases. Diverting ileostomy, if not already in place, may be considered to reduce fecal contamination. For subclinical leaks or those that persist after the initial surgery, endoluminal approaches such as injection of fibrin sealant, use of endoscopic clips, or transanal closure of the very low anastomosis may be utilized. These newer techniques have variable success rates and must be individualized to the patient, with the goal of treatment being restoration of gastrointestinal continuity and healing of the anastomosis. A review of the treatment of low colorectal anastomotic leaks is presented.

• Anastomotic leak
• Colon and rectal surgery
• Colorectal anastomosis
• Management anastomotic leak
• Endoscopic treatment
• Surgical complications

• Anastomotic leakage
• Anterior resection
• Colorectal cancer
• Transanal tube

• Anastomosis, Surgical
• Anastomotic Leak/prevention & control
• Drainage/instrumentation
• Drainage/methods
• Humans
• Odds Ratio
• Rectal Neoplasms/surgery
• Rectum/surgery
• Reoperation
• Surgical Stapling/methods
• Treatment Outcome

• Anastomotic leakage
• Colon surgery
• Endo-sponge
• Endoscopic treatment