Therapeutische strategie bei anastomoseninsuffizienz nach tiefer anteriorer rektumresektion

Introduction: Anastomotic leakage (AL) following low anterior resection for rectal cancer is a complication with a high morbidity and mortality. Thoroughly evaluated treatment strategies do not exist. The aim of the study was to analyze the results of a standardized approach in anastomotic leakage. Methods: From January 1992 through December 2002 all patients with rectal cancer electively undergoing low anterior resection with retroperitonealization of the anastomosis were included. The diagnostic included laboratory parameters, endoscopy, contrast enema and abdominal CT scans. Minor leakage was defined as AL without necessity for surgical intervention (rectoscopic lavage, Endo-VAC and CT-guided drainage, respectively). A major leakage was treated by protective ileostomy, revision of the anastomosis with loop ileostomy or Hartmann's procedure. Results: In 460 patients (238 male, 222 female) a low anterior resection was performed. An anastomotic leakage was diagnosed in 47 patients (overall 10,2%, 17 major leakages (3.7%), 30 minor leakages (6.5%)). 30 patients were treated conservatively by Endo-VAC (n = 21) and CT-guided insertion of a drainage (n = 9), respectively. 17 patients were treated operatively (8 anastomotic revision, 9 ileostomy alone). In 2 patients Hartmann's procedure was necessary. No patient developed a peritonitis. We observed no statistical difference concerning mortality rates between leakage and non-leakage group (4.3% AL vs. 4.8% non-AL). Conclusion: Retroperitonealization of the anastomosis appears to be a reasonable approach to prevent peritonitis in patients with anastomotic leakage following low anterior resection. The introduced treatment pattern lead to decent results in terms of mortality and anorectal function.