Endoscopic Management of Anastomotic Leaks Following Left-Sided Colectomy and Primary Colorectal Anastomosis: A Single-Institution Retrospective Review.

Abstract

BackgroundPostoperative anastomotic leaks are the most common complications following colorectal surgery, with rates reaching 24%. Previous studies on endoscopic management of anastomotic leaks (eg, EndoClip, OverStitch, and stenting) have shown similar outcomes as reoperation. Implementation of these endoscopic strategies for anastomotic leak management remains limited given sparse data demonstrating integration of these methods with conventional practices.MethodsA single-institution, retrospective chart review was conducted to identify patients who underwent a left-sided colectomy with primary colorectal anastomosis and developed clinically significant anastomotic leaks between 2018 and 2021. These patients were categorized as managed with surgery alone vs with endoscopic intervention, and patient demographics and anastomotic leak characteristics were analyzed.ResultsOf the 14 total patients identified, seven were managed with surgery alone and seven were managed with endoscopic intervention. When compared to patients managed with surgery alone, those managed endoscopically were more often hemodynamically normal; however, differences in bowel defect size or time to leak identification were not statistically significant. In three cases, the application of advanced endoscopic techniques prevented the need for further intervention. For three other patients, multidisciplinary management with endoscopy facilitated surgical creation of diverting loop ileostomy instead of a higher-morbidity end colostomy.ConclusionsThis study demonstrates a diversity of scenarios in which endoscopic management can be integrated into management of anastomotic leaks and, in some cases, avoid the need for reoperation. When feasible, a multidisciplinary approach including interventional gastroenterology should be utilized to potentially mitigate the need for end colostomy creation and optimize patient outcomes.