Towards a zero percent anastomotic leak rate using a defined risk reduction strategy

Anastomotic leak (AL) remains one of the most serious complications after colorectal surgery. This study reports prospective data on a defined risk reduction strategy used by one surgeon over a 3-year period.

Using a single surgeon case series with a predefined risk reduction strategy for all anastomoses, a prospectively maintained database on demographic, perioperative, and postoperative outcomes of patients undergoing colorectal resections with formation of anastomosis between January 2017 and July 2020 was evaluated. Data were analysed using descriptive statistics.

There were 145 anastomoses formed in 134 patients. The median age of patients was 67 years (32–87), and the mean body mass index (BMI) was 27.7 kg/m². Seventy-three (50.3%) procedures were performed open and 72 (49.7%) were minimally invasive. Major complications (Clavien–Dindo grade ≥3) occurred in 13 (9.0%) cases. Two patients had an AL (1.3%) that could be treated with antibiotics (grade A). No patient experienced grade B or C leaks (requiring intervention). Median length of hospital stay was 8 days, and 2 patients died within 30-days postoperatively (1.4%).

A predefined risk reduction strategy may help improve patient selection and reduce anastomotic leak rates. A prospective comparative study is warranted.