Techniques for Colorectal Anastomotic Construction Following Proctectomy and Variables Influencing Anastomotic Leak

Abstract

Purpose of ReviewExamine the various technical considerations for pelvic colorectal reconstruction with respective functional and anastomotic healing outcomes. Additionally, several adjuncts to reduce anastomotic complications are individually explored to understand their relative impact on anastomotic healing.Recent FindingsThe benefit of a colorectal reservoir reconstruction instead of a straight anastomosis, in respect to leak and functional outcomes, is marginal, if any. Recent randomized evidence has shown no difference in morbidity, mortality, survival, leakage, or functional outcomes. Unfortunately, anastomotic leakage still occurs in the ideally constructed and managed pelvic anastomosis; however, modifiable variables appear to reduce the risk.SummaryPelvic colorectal anastomosis should be based on the surgeon’s technical ability and comfort level, since the evidence suggests that all techniques are comparable. There may be a slight advantage to colonic J-pouch anastomosis, although this has not been consistently shown. Future studies on the etiology of low anterior resection syndrome may provide insight on optimal reconstruction techniques.