Prevention and treatment of anastomotic leakage after laparoscopic anterior resection of low rectal cancer

doi:10.16139/j.1007-9610.2023.03.008

Abstract

Abstract:

Anastomotic leakage (AL) is one of the inevitable and severe complications after laparoscopic-assisted anterior resection of low rectal cancer. With the improvement of surgical technology and cognitive concept, the position of sigmoid-rectal anastomosis is becoming lower and lower, and the problem of AL is more challenging. Preventive stoma is currently a common method to deal with AL, but over-reliance on stoma and the stoma-related complications have also troubled surgeons. Based on years of practical experience, we summarized how to avoid unnecessary stoma through the risk assessment scale, and how to detect and deal with AL in the early stage of laparoscopic-assisted anterior resection of low rectal cancer.

Key words: Laparoscopy, Anterior resection of low rectal cancer, Anastomotic leakage, Preventive stoma, Risk assessment scale

CLC Number:

R735.37

LUO Yang, ZHONG Ming. Prevention and treatment of anastomotic leakage after laparoscopic anterior resection of low rectal cancer[J]. Journal of Surgery Concepts & Practice, 2023, 28(03): 220-225.

Figures/Tables 6

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Definition	Grade	Clinical manifestation
Subclinical leakage or imaging leakage	A	No special clinical symptoms or signs, only leakage may be detected before stoma closure, which may lead to delayed stoma closure and have hardly impact on recovery
Clinical leakage or significant leakage	B	The peritonitis is not typical or limited, which requires anti-infection and local drainage treatment
Clinical leakage or significant leakage	C	There are clinical manifestations of peritoneal irritation sign and other abdominal infections，requiring emergency surgical intervention

1 point	2 points	3 points
Age≥70 years	Male	Diabetes
BMI≥28 kg/m²	Tumor diameter≥ 3.5 cm	Haemoglobin<90 g/L
Chronic smocking and (or) alcohol abuse	Anastomosis without reinforcement	Albumin<30 g/L
Non-preservation of left colonic artery	Numbers of staplers≥3	Neoadjuvant chemoradiotherapy
Operation time≥ 180 min	Bleeding≥100 mL	Distance from the anastomosis to the dentate line< 1cm
Non-specialized team	Without anal tube	ASA system grading ≥Ⅲ