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Session: ePoster: Benign Abdominal 6 (Mon8)

EP600 - Anastomotic Leak After Colorectal Resections: Management Strategies And Consequences

Monday, May 12, 2025
8:05 AM – 8:10 AM PT
Location: Monitor 1, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • FP

    Felipe A. Pacheco Granda, MD (he/him/his)

    Fellow
    Cleveland Clinic Foundation
    Cleveland, OH, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • Anuradha R. Bhama, MD

    Associate Professor
    Cleveland Clinic
    Cleveland Clinic
    Cleveland, Ohio, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • LD

    Leonardo C. Duraes, MD, PhD

    Associate Staff Colorectal Surgery
    Cleveland Clinic
    Cleveland, Ohio, United States

    Disclosure information not submitted.

  • EG

    Emre Gorgun, MD, MBA

    Vice Chair, Department of Colorectal Surgery
    Cleveland Clinic Foundation-Main Campus
    Cleveland, Ohio, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no relevant relationships with ineligible companies.

  • Jeremy M. Lipman, MD (he/him/his)

    Director of Graduate Medical Education
    Cleveland Clinic Foundation
    Cleveland, Ohio, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • David Liska, MD

    Associate Professor, Chair
    Department of Colorectal Surgery, Cleveland Clinic
    Cleveland Clinic, Cleveland, Ohio
    Cleveland, Ohio, United States

    Disclosure information not submitted.

  • Hermann Kessler, MD, PhD, Professor of Surgery (he/him/his)

    Staff
    Cleveland Clinic Foundation-Main Campus
    Cleveland, OH, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • Scott R. Steele, MD, MBA

    President, Cleveland Clinic, Main Campus Submarket and Rupert B. Turnbull M.D., Endowed Chair in Colorectal Surgery
    Cleveland Clinic
    Cleveland, OH, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • Michael A. Valente, DO

    Associate Professor of Surgery
    Cleveland Clinic
    cleveland, Ohio, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • Stefan D. Holubar, MD, MS, FACS, FASCRS

    Director of Research
    Cleveland Clinic
    Cleveland, Ohio, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no relevant relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Felipe A. Pacheco Granda, MD: This individual has no financial relationships with ineligible companies.
Anuradha R. Bhama, MD: This individual has no financial relationships with ineligible companies.
Emre Gorgun, MD, MBA: This individual has no relevant relationships with ineligible companies.
Jeremy M. Lipman, MD: This individual has no financial relationships with ineligible companies.
Hermann Kessler, MD, PhD, Professor of Surgery: This individual has no financial relationships with ineligible companies.
Scott R. Steele, MD, MBA: This individual has no financial relationships with ineligible companies.
Michael A. Valente, DO: This individual has no financial relationships with ineligible companies.
Stefan D. Holubar, MD, MS, FACS, FASCRS: This individual has no relevant relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Anastomotic leaks (AL) are dread complications after colorectal surgery. Diversion at the index operation can mitigate the consequences of AL, but the short- and long-term outcomes remain poorly understood in this group. We aimed to describe the outcomes associated with different AL management strategies including, operative and non-operative, with a focus on presence or absence of diversion at the index surgery

Methods/Interventions: A retrospective cohort analysis was conducted using the institutional NSQIP database from 2013 to 2023. Patients with documented ileocolic, ileorectal, colorectal, and coloanal AL were included; stump leaks, ileoanal pouch, and small bowel anastomotic leaks were excluded. Charts were reviewed to assess diversion status, type of anastomosis, number of surgeries after the leak, and outcomes related to mortality, ostomy reversal, time to reversal, management strategies, discharge to facility, and ICU stay. Our primary analysis compared rates and timing of ostomy reversal after AL in 3 groups a) patients with diversion at the index operation, b) patients diverted after the leak diagnosis, and c) patients who were not diverted after the leak. Our secondary analysis was to characterize the short- and long-term outcomes after an AL based on diversion status. Univariate descriptive statistics were presented

Results/Outcomes: A total of 7,833 patients were included, with an observed overall AL rate of 2% (158/7,833). After application of exclusion criteria, a total of 101 leaks were analyzed. Overall, the median time to diagnosis was 8 days and the most common AL management strategies included reoperation (63.4% overall) with or without diversion (44.5% and 18.9% respectively), while a substantial proportion (36.6% of the cohort) underwent non-operative management typically with percutaneous drainage (72.2% [26/37], or 25.7% overall). The type of anastomosis significantly influenced AL management strategies; coloanal and colorectal anastomoses had higher index diversion rates (84.2% and 23.7%, respectively). In terms of outcomes, overall, 32.7% required ICU, 13.9% were discharged to a facility, the 30-day mortality rate was 3%, and 64.4% required readmission. AL management strategies were significantly different in the operative group (Table 1), while outcomes after AL (Table 2) were not significantly different based on diversion status. Moreover, no significant differences in the length of stay, time to AL diagnosis, or time to reversal were noted. The number of surgeries after the AL was significantly different across the groups. Overall, 79.2% of patients had intestinal continuity restored after diversion. No significant difference in 30-day mortality was noted between the groups

Conclusion/Discussion: This study highlights the management strategies employed based on whether an AL was already, or subsequently required diversion. Likely due to peritonitis, AL in patients who went on to diversion were detected earlier than those already diverted or who did not require subsequent diversion. Most of those leaks (59.1%) were managed with anastomotic takedown. Interestingly, 36.6% were managed non-operatively likely representing small/contained leaks, most commonly with percutaneous drains; overall, 24% of leaks were never diverted. While selection bias likely influenced our results, index vs. subsequent diversion was not associated with significant differences in 30-day mortality, reversal rates, or time to restoration, and most patients achieved restoration of intestinal continuity