Reducing anastomotic leak in colorectal surgery: The old dogmas and the new challenges

World J Gastroenterol. 2019 Sep 14;25(34):5017-5025. doi: 10.3748/wjg.v25.i34.5017.


Anastomotic leak (AL) constitutes a significant issue in colorectal surgery, and its incidence has remained stable over the last years. The use of intra-abdominal drain or the use of mechanical bowel preparation alone have been proven to be useless in preventing AL and should be abandoned. The role or oral antibiotics preparation regimens should be clarified and compared to other routes of administration, such as the intravenous route or enema. In parallel, preoperative antibiotherapy should aim at targeting collagenase-inducing pathogens, as identified by the microbiome analysis. AL can be further reduced by fluorescence angiography, which leads to significant intraoperative changes in surgical strategies. Implementation of fluorescence angiography should be encouraged. Progress made in AL comprehension and prevention might probably allow reducing the rate of diverting stoma and conduct to a revision of its indications.

Keywords: Anastomosis; Anastomotic leakage; Colic surgery; Complication; Prevention; Rectal surgery; Surgical site infection.

Publication types

  • Review

MeSH terms

  • Anastomosis, Surgical / adverse effects
  • Anastomotic Leak / epidemiology
  • Anastomotic Leak / etiology
  • Anastomotic Leak / prevention & control*
  • Anti-Bacterial Agents / administration & dosage
  • Cathartics / administration & dosage
  • Colon / diagnostic imaging
  • Colon / microbiology
  • Colon / surgery*
  • Enema
  • Fluorescein Angiography
  • Gastrointestinal Microbiome / drug effects
  • Humans
  • Incidence
  • Preoperative Care / adverse effects
  • Preoperative Care / methods*
  • Rectum / diagnostic imaging
  • Rectum / microbiology
  • Rectum / surgery*
  • Surgical Wound Infection / etiology
  • Surgical Wound Infection / prevention & control*
  • Treatment Outcome


  • Anti-Bacterial Agents
  • Cathartics