ORIGINAL ARTICLE   

Chirurgia 2022 June;35(3):147-54

DOI: 10.23736/S0394-9508.21.05306-7

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Successful colorectal anastomotic leakage management: a two oncological centres’ 12-year experience

Kiril G. KIROV ^{1, 2} ✉, Tsvetomir M. IVANOV ³, Nadya S. IVANOVA ⁴

¹ Research Institute, Medical University of Pleven, Pleven, Bulgaria; ² Complex Oncology Center of Shumen, Shumen, Bulgaria; ³ Clinic of Oncological Surgery, Georgi Stranski University Hospital of Pleven, Pleven, Bulgaria; ⁴ St. Marina HIFU Center, St. Marina Hospital of Pleven, Pleven, Bulgaria

BACKGROUND: Colorectal anastomotic leakage represents a potentially life-threatening complication of colorectal surgery which incidence rate has not considerably diminished over time. Our purpose was to share the results from the successful management of the patients with colorectal anastomotic leakage.
METHODS: During the period between June 1^st, 2008 and August 31^st, 2020, a total of 823 patients with rectal and rectosignoid cancer were operated on. Patients’ demographic parameters and clinical characteristics such as concrete diagnosis, TNM stage, differentiation grade, and ASA class were analyzed.
RESULTS: The incidence rate of this complication during the whole study was 4.37%. A hand-sewn sero-muscular second-floor was made in all the stapled anastomoses. Usage of protective ostomy resulted in smaller total and mean perioperative blood loss, shorter duration of surgery, much smaller 30-day mortality rate as well as much seldom severity grade C leakage. The application of the temporary protective ostomy creation combined with presacral drainage underlied the effective strategy for control of the life-threatening sepsis and accelerated anastomosis healing. Double-barreled ostomy placement enabled a minimally invasive intestinal passage restoration and improved individual patient’s quality of life.
CONCLUSIONS: Our results clearly demonstrated that proper patient’s selection and diagnosis along with individualized surgical management including timely protective ostomy, drain lavage, hand-sewn sero-muscular second-floor in stapled anastomoses and double-barreled transversostomy enabled a successful prevention and treatment of the colorectal anastomotic leakage.

KEY WORDS: Surgical anastomosis; Ostomy; Therapeutic irrigation