Through clinical cases examples, Dr. Ke discusses the importance of anastomotic leakage. The leak rate described in the literature ranges from 1.5 to 20%, with a re-operative rate of 2.5 to 7.6% and significant associated morbimortality. Anastomotic leakage may also increase irregular bowel function, worsen the quality of life, and increase cancer mortality, distant recurrence and local recurrence in the long term.
Anastomotic leakage may be treated non-operatively through drainage, endosponge or fibrin glue, among other techniques. Operative treatments include peritoneal lavage, diversion stoma, re-doing the anastomosis, Hartmann´s procedure, and transanal repair. The laparoscopic approach to anastomotic leakage has demonstrated to be safe and feasible with benefits over the open approach.
Dr. Ke describes his experience with the hybrid laparoscopic and transanal approach on 18 patients out of 38 patients with anterior resection from 2012 to 2015. Several explanatory videos are shown, including the use of TAMIS to repair a leak as well as the combined laparoscopic and transanal approach.
