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Anastomotic Dehiscence and Fistulization

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Anal Fistula and Abscess

Part of the book series: Coloproctology ((COLOPROCT))

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Abstract

Anastomotic leak is a fearsome complication that may occur after abdominal surgery. Its incidence is variable in the literature, being higher for distal anastomotic sites. Anastomotic leak should be graded according to severity and the intervention required. In case of a pelvic anastomosis, an abscess at this site has to be considered as a leak. The etiology of such a complication is multifactorial. Several factors contribute to its pathogenesis, namely immune system, inflammation host genetics, and gut microbiome. Several risk factors are associated with an increased risk of developing an anastomotic leak, such as male gender, high BMI and ASA, steroids use, malnutrition, smoking, diabetes, and neoadjuvant treatment. Microbiome characteristics, NSAIDs use, tumor characteristics, and preoperative bowel preparation may also have an impact on anastomotic leak. CT scan is considered the gold standard for the diagnosis of a leak. Some clinical tools such as the DULK score may help physician through diagnosis and treatment. Once the leak is diagnosed, a number of treatments is available, from nonoperative management to endoscopy and surgery. Frequently, if not already present a stoma formation is mandatory in order to treat a leak. Anastomotic leak may affect long-term outcomes. A higher rate of local recurrence has been demonstrated for patients who develop a leak after rectal cancer surgery.

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Humanitas Clinical and Research Center IRCCS, Milan, Italy

    Nadav Ben David, Jacopo Crippa, Caterina Foppa & Antonino Spinelli

  2. Department of Biomedical Sciences, Humanitas University, Milan, Italy

    Antonino Spinelli

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  1. Nadav Ben David
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  2. Jacopo Crippa
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  3. Caterina Foppa
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  4. Antonino Spinelli
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Correspondence to Antonino Spinelli .

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Editors and Affiliations

  1. Clinica Chirurgica, Catholic University, ROMA, Roma, Italy

    Carlo Ratto

  2. Dept. of Abdominal Surgery, Catholic University, ROMA, Roma, Italy

    Angelo Parello

  3. Dept. of Abdominal Surgery, Catholic University, ROMA, Roma, Italy

    Francesco Litta

  4. Dept. of Abdominal Surgery, Catholic University, Roma, Italy

    Veronica De Simone

  5. Proctology Unit, Dept. of Abdominal Surg, Foundation University Hospital “A. Gem, Roma, Roma, Italy

    Paola Campennì

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  1. Division of Colon and Rectal Surgery, Humanitas Clinical and Research Center, Rozzano Milan, Italy

    Paola Campennì

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Ben David, N., Crippa, J., Foppa, C., Spinelli, A. (2021). Anastomotic Dehiscence and Fistulization. In: Ratto, C., Parello, A., Litta, F., De Simone, V., Campennì, P. (eds) Anal Fistula and Abscess. Coloproctology. Springer, Cham. https://doi.org/10.1007/978-3-030-30902-2_44-1

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