Techniques for Colorectal Anastomotic Construction Following Proctectomy and Variables Influencing Anastomotic Leak
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Purpose of Review
Examine the various technical considerations for pelvic colorectal reconstruction with respective functional and anastomotic healing outcomes. Additionally, several adjuncts to reduce anastomotic complications are individually explored to understand their relative impact on anastomotic healing.
The benefit of a colorectal reservoir reconstruction instead of a straight anastomosis, in respect to leak and functional outcomes, is marginal, if any. Recent randomized evidence has shown no difference in morbidity, mortality, survival, leakage, or functional outcomes. Unfortunately, anastomotic leakage still occurs in the ideally constructed and managed pelvic anastomosis; however, modifiable variables appear to reduce the risk.
Pelvic colorectal anastomosis should be based on the surgeon’s technical ability and comfort level, since the evidence suggests that all techniques are comparable. There may be a slight advantage to colonic J-pouch anastomosis, although this has not been consistently shown. Future studies on the etiology of low anterior resection syndrome may provide insight on optimal reconstruction techniques.
KeywordsLow anterior resection Proctectomy Colorectal anastomosis Anastomotic leak Colonic pouch anastomosis Coloplasty
Compliance with Ethical Standards
Conflict of Interest
The authors declare they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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