Management of Anastomotic Leaks After Elective Colorectal Resections: The East of England Experience - A Retrospective Cohort

The International Study Group of Rectal Cancer proposed a grading system for the management of colorectal anastomotic leaks (Rahbari et al., 2010). Grade A anastomotic leaks are identified by radiographic findings of a perianastomotic fluid collection, leakage of contrast through the anastomosis, or observation of new drainage of enteric contents through either a drain or through a fistula but without accompanying clinical complaints. These may be managed expectantly. These may become apparent during the preoperative work-up prior to closure of a diverting ostomy and will at least delay reversal. Grade B leakage requires therapeutic intervention but does not necessarily require reoperation. Antibiotics and percutaneous drainage of fluid collections are the most common nonoperative interventions. Grade C anastomotic leakage requires relaparotomy. Surgical treatment is performed with the goal of controlling life-threatening sepsis. The traditional operation with takedown of the anastomosis and end colostomy may be appropriate, but washout with drain placement and diverting loop ileostomy may also be appropriate. 1 Elective colorectal resection surgeries have an over 30-day mortality rate of 5.8%. While emergency resections have a 7.8% mortality (Morris, 2011). Experiencing an anastomotic leaks should not have a higher mortality than the above rates.

Aim The main interest of this study is to firstly assess our practice and management of AL, evaluate whether hospitals in the region are identifying AL as per The International Study Group of Rectal Cancer, grading the AL as Grade A, B, and C above, and analyse the natural evolution of leaks and their subsequent treatment(s).

Outcomes of Interest

Management of anastomotic leaks and associated outcome in terms of:

Primary objectives: