Page 11 - Laparoscopic Journal - WJOLS

WJOLS
WJOLS

10.5005/jp-journals-10033-1245
Anastomotic Leak in Laparoscopic Colorectal Surgery: Risk Factors and Prevention
revieW articLe

Anastomotic Leak in Laparoscopic Colorectal Surgery:

Risk Factors and Prevention

Abdullah Badawi

ABSTRACT patients who underwent laparoscopic colorectal surgeries
Background: Anastomotic leakage (AL) is a common compli- were collected.
cation and still is a significant problem following laparoscopic
colorectal surgery. Risk factors and prevention for AL are not MeThodS
well-defined.
A systematic search of electronic databases (PubMed,
Methods: A systematic search of electronic databases. Cohort,
case-control studies and randomized controlled trials that exa- NCBI, Annals journal, WJOLS, SLS journal, WJGS,
mined clinical risk factors and prevention for AL were included. Medscape and UpToDate) for 31 studies published from
January 2009 to September 2015 was performed. Cohort,
Conclusions: In conclusion, tumor location ≤ 6 cm from the
anal verge, tumor size > 5 cm, preservation of the left colic case-control studies and randomized controlled trials
artery, male gender, severe malnutrition, body mass index (BMI) that examined clinical risk factors and prevention for
≥ 25, preoperative Neoadjuvant therapy and steroid therapy, AL were included.
American Society of Anesthesiologists (ASAs) score ≥ 3, tobacco
abuse, operating time ≥ 180 minutes, precompression before InTRoduCTIon
stapler firing and multiple firing of the stapler are associated with
increase the risk of developing AL. On the other hand, Improve Since the beginning of laparoscopic surgery, minimally
nutritional status, control comorbidities, stop smoking at least access techniques have been used by surgeons and gyne -
2 weeks before surgery and preoperative use of mechanical
bowel preparation, assessment and subsequent adaptation cologists for multiple elective procedures, some emer-
of operative technique without multiple firings of stapler or gency procedures, benign and malignant tumors. In
precompression before stapler firings and the use of transanal 1987, big step toward the minimally invasive techniques
tube postoperatively, showed decrease in the AL rate following and away from more invasive open techniques, after the
laparoscopic colorectal procedures.
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promising outcome of the laparoscopic cholecystectomy.
Keywords: Anastomotic leak, Colon cancer, Colorectal cancer, The first laparoscopic colectomy was reported in 1991
Laparoscopic colorectal surgery, Laparoscopy, Prevention of
anastomotic leakage, Risk factor of anastomotic leakage. by Jacobs et al and showed better outcome and less
recovery period. 41
How to cite this article: Badawi A. Anastomotic Leak in Lapa-
roscopic Colorectal Surgery: Risk Factors and Prevention. World Many surgeons performed laparoscopic colectomy for
J Lap Surg 2015;8(2):43-47. benign diseases, oncologic concerns made the application
of minimally access surgery (MAS) to malignant colo-
Source of support: Nil
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rectal disease slow. By the time, after numerous studies
Conflict of interest: None (randomized controlled trials) comparing laparoscopic
to open surgery for colon cancer were published, were
BACkgRound
showed that in experienced hands, appropriate oncologic
Anastomotic leakage (AL) is a common complication and resections can be performed and the results of laparo-
still is a significant problem following laparoscopic colo- scopic techniques equivalent to the open techniques. 43-46
rectal surgery. Risk factors for AL are not well-defined. After the minimally access procedures became widely
Herein, data analysis and systematic review to quan- accepted, many surgical innovators and industries develop
tify the predictive risk factors for AL and prevention in new technology with even less invasive appro aches.
Single-incision laparoscopic surgery (SILS) allows the
48
surgeons to operate through single incision. Robotic
Surgical Resident procedures at the beginning was popular in other spe-
Department of Surgery, King Abdulaziz General Hospital and cialties, such as urology, and some surgeries for rectal
Trauma Center, Jeddah, Saudi Arabia cancer to overcome the limitations of conventional
Corresponding Author: Abdullah Badawi, Surgical laparoscopy in the confined working space of the
Resident, Department of Surgery, King Abdulaziz General pelvis. 49,50 In 2000, the da Vinci Surgery System broke
Hospital and Trauma Center, Jeddah, Saudi Arabia, Phone: new ground by becoming the first robotic surgery system
00966126375555, e-mail: dr.abdullah_badawi@hotmail.com
approved by the FDA for general laparoscopic surgery.
World Journal of Laparoscopic Surgery, May-August 2015;8(2):43-47 43