Taming colonic anastomotic leakage: Wisdom from the ancient Chinese legend of Yu the Great

Abstract

Colonic anastomotic leakage (AL) remains the most severe complication of colorectal surgery, significantly increasing morbidity, mortality, and healthcare burdens. The ideal solution - complete AL prevention without a defunctioning stoma - has long eluded surgeons and patients. Hu et al proposed total enteric flow diversion using a modified ileostomy tube with an inflatable balloon, demonstrating its efficacy in completely preventing AL in porcine models. This innovation echoes the ancient legend of Yu the Great, a Chinese hero renowned for taming the Yellow River’s catastrophic floods. Unlike his father, who failed by merely building embankments to block water, Yu succeeded by dredging channels to redirect floods seaward. This paradigm of “diversion over obstruction” applies equally to AL prevention. Beyond Hu et al’s balloon technique, alternatives like the C-seal, the SafeHeal Colovac+ anastomosis protection device and Tong et al’s biodegradable stent-based diverting techniques show promise in clinical trials. Key challenges remain: Diversion efficiency, device migration risks, and patient tolerance. We must accelerate such like breakthroughs in non-stoma diversion strategies to transform AL management.

Keywords: Colonic anastomotic leakage; Diverting stoma; Intraluminal bypass device; Stent-based diverting technique; Yu the Great Tames the Flood

Core Tip: Yu the Great did not conquer water by building higher walls; he tamed it by carving new paths. Colonic anastomotic leakage prevention must likewise redirect, not exclude, intestinal flow. Despite promising results from devices that practice Yu’s diversion concept - including the C-seal, SafeHeal Colovac+, the biodegradable diverting stent, and water-inflatable balloons - accelerating breakthroughs in non-stoma strategies remains crucial to transforming anastomotic leakage management.