Management of the Patients With Anastomotic Breakdown Following Low Anterior Rectal Resection

This is the authors' abstract. We don't add key points for this paper.

Out of 130 rectal cancer patients undergone low anterior resection, 20 (15.4%) developed anastomotic breakdown. The 20 patients were classified into major leak group (8) and minor leak group (12), according to the severity of clinical features and to the amount of leakage load, and were studied in terms of the contributing factors to the breakdown and the best management for dehiscence.Risk factors significantly contributing to the breakdown were hypoproteinemia, blood transfusion and duration of operation. Mean interval between initial operation and the detection of anastomotic leakage was significantly shorter in the major group (5.9 days) than in the minor group (10.9 days).All patients in the minor leak group could be successfully managed with conservative treatments, whereas 7 of the 8 major leak patients needed operative treatment such as drainage and proximal diverting colostomy. Overall mortality of the patients with anastomotic breakdown was 10% (2/20), both two died of major leakage.For major leakage, a patient with drainage alone died, while among 6 patients with drainage and diverting colostomy, only one died.It is suggested that diverting colostomy is indispensably needed for the treatment of major anastomotic breakdown following low anterior resection.