Anastomotic Leak

Breakdown of the connection and subsequent leakage of effluent (fluids, secretions, air) from a SURGICAL ANASTOMOSIS of the digestive, respiratory, genitourinary, and cardiovascular systems. Most common leakages are from the breakdown of suture lines in gastrointestinal or bowel anastomosis.

Also Known As:

Networked: 4306 relevant articles (213 outcomes, 478 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Rectal Neoplasms (Rectal Cancer)
2.	Pathologic Constriction (Stenosis)
3.	Fistula
4.	Neoplasms (Cancer)
5.	Hemorrhage

Experts

1.	Lange, Johan F: 22 articles (01/2022 - 02/2006)
2.	van Hillegersberg, Richard: 16 articles (07/2022 - 08/2012)
3.	Gisbertz, Suzanne S: 14 articles (07/2022 - 10/2016)
4.	Luyer, Misha D P: 14 articles (07/2022 - 04/2013)
5.	van Berge Henegouwen, Mark I: 14 articles (07/2022 - 06/2010)
6.	Nieuwenhuijzen, Grard A P: 14 articles (04/2022 - 04/2013)
7.	Kleinrensink, Gert-Jan: 14 articles (01/2022 - 07/2009)
8.	Kiran, Ravi P: 12 articles (12/2016 - 03/2009)
9.	Kitagawa, Yuko: 11 articles (09/2022 - 03/2014)
10.	Alverdy, John C: 11 articles (12/2021 - 01/2012)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Anastomotic Leak:

1.	Indocyanine Green (Cardio-Green)FDA LinkGeneric 01/01/2021 - "Assessment of anastomotic blood perfusion with intraoperative indocyanine green fluorescence angiography (ICG-FA) may be effective in preventing anastomotic leak compared with standard intraoperative methods in colorectal surgery. " 03/01/2020 - "Whether indocyanine green fluorescence angiography (ICG-FA) during rectal surgery is effective in reducing anastomotic leakage remains unclear. " 01/01/2021 - "Indocyanine green fluoroscopy has been shown to improve anastomotic leak rates in early phase trials. " 06/01/2020 - "The aim of this study was to evaluate the efficacy of indocyanine green (ICG) fluorescence angiography with respect to the anastomotic leakage rate for patients undergoing colorectal operations. " 12/01/2020 - "We performed this systematic review and meta-analysis to evaluate the efficacy of indocyanine green fluorescence angiography in decreasing anastomotic leakage. "
2.	Fibrin Tissue Adhesive (Fibrin Sealant)IBA 08/04/2012 - "Adhesive film is more effective in reducing anastomotic leakage than fibrin glue." 02/01/1987 - "We conclude that fibrin glue is effective in lessening the incidence of esophagogastric anastomotic leaks as employed in this experimental model." 01/01/2019 - "Future studies may investigate the possible protective effects of fibrin sealant application on the development of anastomotic leakage. " 12/01/2004 - "The aims of this study were to (1) develop an iatrogenic leak model in swine, (2) examine the efficacy of fibrin sealant in sealing iatrogenic anastomotic leak, and (3) review our experience with the use of fibrin sealant in 66 patients who underwent laparoscopic GBP. " 05/14/2020 - "After endoscopic injection of human fibrin sealant in all 7 patients with intrathoracic anastomotic leakage, the volume of para-anastomotic drainage, CRP, and WBC count were improved compared with those before treatment. "
3.	Anti-Bacterial Agents (Antibiotics)IBA 12/24/2021 - "Meta-analysis results showed a statistically significant reduction of SSIs (OR 0.54, 95% CI 0.40 to 0.72; p < 0.0001) and anastomotic leakage (OR 0.55, 95% CI 0.33 to 0.91; p = 0.02) in the group of patients receiving oral antibiotics in addition to intravenous (IV) antibiotics compared to IV alone. " 05/15/2023 - "Recent studies suggest that the combined use of preoperative mechanical bowel preparation and oral antibiotics may have a preventive effect on anastomotic leakage. " 01/09/2023 - "Mechanical bowel preparation combined with oral antibiotics reduces infectious complications and anastomotic leak in elective colorectal surgery: a pooled-analysis with trial sequential analysis." 05/23/2022 - "This study will examine whether oral antibiotic bowel preparation (OABP) influences the incidence of anastomotic leakage after surgery in a prospective, multicentre, randomized controlled trial that will enrol 1500 patients who require colon surgery. " 09/01/2018 - "This non-randomised study adds 'real-world', contemporaneous, and prospective evidence of the beneficial effects of combined mechanical bowel preparation and oral antibiotics in the prevention of anastomotic leak following left sided colorectal resection across diverse settings. "
4.	C-Reactive ProteinIBA 10/01/2013 - "The predictive value of C-reactive protein (CRP) as a marker of infective postoperative complications, particularly in the form of anastomotic leakage, has been investigated by several authors with promising results. " 08/01/2023 - "Serum C-reactive protein (CRP) is commonly used by surgeons to raise suspicion of anastomotic leakage and other infectious complications, but most studies on optimal cut-off values are retrospective with a small sample of patients. " 04/10/2023 - "Prior studies suggest postoperative C-reactive protein (CRP) trends are sensitive for predicting anastomotic leak (AL) after elective colorectal surgery. " 08/01/2022 - "The primary objective of this study was to assess the role of C-reactive protein (CRP) as a tool to facilitate the early diagnosis of large bowel anastomotic leak. " 01/01/2022 - "The aim of this study was to evaluate the role of the C-reactive protein (CRP) and white cell count (WC) in the prediction of anastomotic leakage (AL) in major abdominal surgery. "
5.	MetalsIBA 02/01/2003 - "Our case report demonstrates that transesophageal placement of a selfexpandable metal stent in combination with interventional drainage of the paraesophageal space is a safe and effective procedure in the management of a mediastinal anastomotic leaks." 01/01/2020 - "We aimed to validate this score in a cohort of patients with anastomotic leaks managed with self-expanding metal esophageal stents, by assessing technical and clinical success rates and comparing the agreement between the predicted and the actual clinical success. " 12/01/2019 - "Major complications (grade ≥3) were seen in 19 (22%), including anastomotic leak in 2 (2.3%), both successfully treated with temporary covered metal stent. " 04/01/2016 - "Treatment of esophageal anastomotic leakage with self-expanding metal stents: analysis of risk factors for treatment failure." 03/01/2014 - "Recently, self-expanding metal stents (SEMS) were introduced to treat anastomotic leaks. "
6.	VancomycinFDA LinkGeneric 02/01/1997 - "Decontamination with polymyxin, tobramycin, vancomycin, and amphotericin B during anastomotic wound healing is safe and effective in the prevention of esophagojejunal anastomotic leakage after total gastrectomy." 05/01/2020 - "Local decontamination with polymyxin, tobramycin, vancomycin, and amphotericin B is safe and effective in the prevention of anastomotic leak in rectal cancer surgery." 04/01/1997 - "The results of a prospective double-blind placebo-controlled multicenter trial indicate that perioperative i.v. prophylaxis with cefotaxim and topical decontamination with polymyxin B, tobramycin, vancomycin and amphotericin B from the day before surgery until the 7th postoperative day is most effective in the prevention of esophagojejunal anastomotic leakage following total gastrectomy. "
7.	Tobramycin (Nebcin)FDA LinkGeneric 02/01/1997 - "Decontamination with polymyxin, tobramycin, vancomycin, and amphotericin B during anastomotic wound healing is safe and effective in the prevention of esophagojejunal anastomotic leakage after total gastrectomy." 05/01/2020 - "Local decontamination with polymyxin, tobramycin, vancomycin, and amphotericin B is safe and effective in the prevention of anastomotic leak in rectal cancer surgery." 04/01/1997 - "The results of a prospective double-blind placebo-controlled multicenter trial indicate that perioperative i.v. prophylaxis with cefotaxim and topical decontamination with polymyxin B, tobramycin, vancomycin and amphotericin B from the day before surgery until the 7th postoperative day is most effective in the prevention of esophagojejunal anastomotic leakage following total gastrectomy. "
8.	Amphotericin B (Amphotericin)FDA LinkGeneric 02/01/1997 - "Decontamination with polymyxin, tobramycin, vancomycin, and amphotericin B during anastomotic wound healing is safe and effective in the prevention of esophagojejunal anastomotic leakage after total gastrectomy." 05/01/2020 - "Local decontamination with polymyxin, tobramycin, vancomycin, and amphotericin B is safe and effective in the prevention of anastomotic leak in rectal cancer surgery." 04/01/1997 - "The results of a prospective double-blind placebo-controlled multicenter trial indicate that perioperative i.v. prophylaxis with cefotaxim and topical decontamination with polymyxin B, tobramycin, vancomycin and amphotericin B from the day before surgery until the 7th postoperative day is most effective in the prevention of esophagojejunal anastomotic leakage following total gastrectomy. "
9.	Biomarkers (Surrogate Marker)IBA 04/01/2017 - "Biomarkers, which may help to predict anastomotic leakage before appearance of its clinical features, may be beneficial in preventing adverse outcomes. " 11/22/2023 - "In this study, we investigated the role of several circulating and drainage fluid biomarkers for detecting postoperative complications (PCs) and anastomotic leakage (AL) in patients undergoing colorectal surgery. " 09/10/2022 - "The Significance of Blood and Peritoneal Fluid Biochemical Markers in Identifying Early Anastomotic Leak following Colorectal Resection-Findings from a Single-Center Study." 01/01/2022 - "Detection of Anastomotic Leakage Following Elective Colonic Surgery: Results of the Prospective Biomarkers and Anastomotic Leakage (BALL) Study." 12/01/2020 - "Multiple studies have attempted to identify biomarkers to enable earlier diagnosis of anastomotic leak. "
10.	ProcalcitoninIBA 01/01/2017 - "The aim of this study is to determine whether serum procalcitonin is a good predictor of anastomotic leak in colorectal surgery. " 04/01/2022 - "Diagnostic accuracy of procalcitonin on POD3 for the early diagnosis of anastomotic leakage after colorectal surgery: A meta-analysis and systematic review." 01/01/2022 - "A Commentary on "Diagnostic accuracy of procalcitonin on POD3 for the early diagnosis of anastomotic leakage after colorectal surgery: A meta-analysis and systematic review" (Int. " 01/01/2020 - "Diagnostic accuracy of procalcitonin for the early diagnosis of anastomotic leakage after colorectal surgery: a meta-analysis." 04/01/2017 - "High serum CRP and procalcitonin values on post-operative day three are alarming, and assessment of anastomotic leakage by abdominal imaging with rectal contrast is suggested. "

Therapies and Procedures

1.	Stents 08/01/2013 - "It is known that anastomotic leakages particularly situated in the chest can be successfully treated with endoscopically placed self-expanding stents with/without additional drainage. " 08/01/2001 - "The cohort treated without stents and H-2 blockade was at significantly greater risk for anastomotic leakage. " 03/01/2019 - "Both biliary stent and nasobiliary tube were more effective in managing non-anastomotic leaks compared to anastomotic leaks." 12/01/2016 - "Although oesophageal stenting is a safe option for the leaks, stent migration and failure to completely cover large anastomotic leaks are the main complications and pitfalls of the procedure. " 08/01/2015 - "Esophageal stent for the treatment of a perforation or anastomotic leak has been shown to be effective and safe. "
2.	Esophagectomy 07/01/2016 - "Anastomotic omentoplasty has been used and proven effective in preventing anastomotic leaks after an esophagectomy. " 02/01/2023 - "In our experience, surgical treatment as the first approach for TBEF associated with anastomotic leak after esophagectomy obtained good results. " 02/24/2023 - "For esophagogastric anastomosis in the neck after esophagectomy, hand-sewn anastomosis is superior to circular stapled anastomosis with regard to reducing the risk of anastomotic leakage." 05/01/2017 - "Preoperative ischemic conditioning by arterial embolization before oncologic esophagectomy seems to be effective in preventing anastomotic leakage." 01/01/2020 - "Omentoplasty after esophagectomy is a safe and effective method to prevent anastomotic leakage."
3.	Therapeutics 04/01/2023 - "Goal-directed therapy utilising oesophageal Doppler was the most effective in reducing anastomotic leak (SUCRA = 79%, OR = 0.45, 95% CrI = 0.12 to 1.5). " 01/01/2016 - "The anastomotic leakage occurred in nine beagles, most of them (8/9) were cured after supportive therapy. " 05/01/2022 - "Owing to the promising results and the excellent risk profile, EVT has become the therapy of choice for perforations and anastomotic leakages of the upper gastrointestinal tract in many centers of expertise. " 12/29/2022 - "Yorkshire pigs are good animal models for studying the safety and efficacy of endoluminal vacuum therapy and prior studies have employed these devices in rectal anastomotic defects, as rescue therapy for early anastomotic leaks, as well as prophylactic therapy as a means of protecting high risk anastomosis. " 01/01/2019 - "Accumulating evidence indicates that anastomotic leakages and perforations of the upper gastrointestinal tract (uGIT) can be treated successfully with endoscopic vacuum therapy (EVT). "
4.	Length of Stay 05/25/2023 - "We identified significant decreases in ICU admission rates (OS 19.0%, RS 9.5%, p = 0.01) and anastomotic leak rates (OS 4.4%, RS 0.8%, p = 0.04), with borderline improvement in overall length of stay (OS 9.9, RS 8.9 days, p = 0.05). " 01/01/2021 - "The use of intraoperative ICG fluorescence angiography was linked with a significant reduction in all grades anastomotic leak (OR 0.39 (95 per cent c.i. 0.31 to 0.49), P < 0.001; number needed to treat for an additional beneficial outcome (NNTB) 23) and length of hospital stay (MD -0.72 (95 per cent c.i. -1.22 to -0.21) days, P = 0.006). " 02/01/2022 - "Both approaches have advantages and disadvantages: The Merendino procedure showed reduced incidence of anastomotic leakage and shorter hospital stay but was associated with a higher in-hospital mortality rate. " 04/01/2019 - "However, evolution in fast track protocols over time showed, an overall improvement in length of stay, anastomotic leak, pulmonary complications and mortality over time. " 01/01/2022 - "The secondary outcomes included the incidence of anastomotic leakage (AL), efficacy of airway clearance, and postoperative hospital length of stay (LOS). "
5.	Conservative Treatment 10/01/1996 - "Most anastomotic leaks were cured by conservative treatment. " 07/01/2013 - "One male patient (overall 2.5%) developed clinical anastomotic leakage, but responded well to conservative treatment. " 01/01/2022 - "Two patients had postoperative anastomotic leakage, which was cured after conservative treatment. " 03/01/2021 - "Two patients who went through anastomotic leakage were cured by drainage and conservative treatments. " 01/01/2016 - "Anastomotic leakage was improved with conservative therapy and he was discharged 76 days after the second operation. "