Dr. Aurelia Wildeboer

Why do anastomoses (still) leak? 5 Thing you should know about intestinal anastomotic healing

Anastomotic leakage (AL) is still one of the most frequent and feared complications in gastrointestinal surgery. In AL, the enteric content contaminates the peritoneal cavity and causes considerable morbidity and/or mortality. Despite evolving surgical techniques and improved perioperative care, the reported incidence of AL is 2.8-30%, which has not significantly declined in the last decades. So why is this the case? Why are our anastomoses (still) leaking? One of the frequently reported reasons is the multifactorial nature of the problem, as this makes it hard to pinpoint and tackle specific causes. However, another often more overlooked reason is that we lack sufficient knowledge of the actual processes that govern anastomotic leakage/healing. In other words: we cannot effectively prevent or treat what we don’t understand. So in order to understand why our anastomoses are (still) leaking, we have to know more about anastomotic healing.  Therefore this surgical open classroom aims to: Raise awareness of the existing knowledge gap Provide insight into what we do know about anastomotic healing (parallels to skin healing, animal studies) Create a theoretical framework for the processes of leakage: the hallmarks of anastomotic failure Take home messages: AL incidence has not changed in the last decades We can still do better in improving modifiable risk factors Most mechanisms of anastomotic leakage and healing are unknown Anastomotic healing differs significantly from cutaneous wound healing in collagen and collagenase activity, wound strength and wound environment Better understanding of healing is necessary to progress in AL research and achieve lasting reductions of leakage incidence