Factors associated with leaks:
- Operative
- Anastomosis related: tension, blood supply, low anastomosis, failure of leak test
- General operative: poor technique, blood loss, length of surgery, bowel prep
- Patient
- Comorbidities: Immunocompromised, Diabetes, Malnutrition, COPD, Obesity, Connective tissue disorders
- Prior abdominal surgery or radiation
- Physiology: Anaemia, vasopressors
- Lifestyle: Smoking, Alcohol
- Disease
- IBD, diverticular
- Emergency surgery
Treatment
- Usually surgical resection and stoma
- Some stable patients can be managed expectantly with bowel rest, broad-spectrum antibiotics and perc drain
- Some low anastomoses can be managed with diverting stoma + transanal drainage
- Endoscopic +/- VAC can be utilised in select cases.