From the Guidelines
Immediate complications after a low anterior resection that should be prioritized include anastomotic leakage, bleeding, and urinary retention, as these can significantly impact morbidity, mortality, and quality of life. According to the most recent guidelines, such as those from the ERAS® Society recommendations part 2-emergency laparotomy: intra- and postoperative care 1, it is crucial to focus on preventing and managing these complications.
Key Complications
- Anastomotic leakage is a serious complication, occurring in 3-15% of cases, and presents with fever, abdominal pain, tachycardia, and purulent or fecal drainage, as noted in studies like Kang CY, Halabi WJ, Chaudhry OO et al (2013) [@2@].
- Bleeding may occur at the anastomotic site or in the pelvis, requiring transfusion or reoperation in severe cases.
- Urinary retention affects up to 30% of patients due to pelvic nerve manipulation and requires catheterization for 24-48 hours. Other potential complications include ileus, wound infection, sexual dysfunction, fecal incontinence, and anterior resection syndrome characterized by frequent, urgent bowel movements.
Management and Monitoring
Close monitoring of vital signs, abdominal examination, drain output, and early mobilization are essential for prompt detection and management of these complications. Patients should be informed about the possibility of temporary or permanent stoma creation if complications are severe. The most recent and highest quality study, such as the 2023 consensus guidelines for perioperative care for emergency laparotomy enhanced recovery after surgery (ERAS®) society recommendations part 2-emergency laparotomy: intra- and postoperative care 1, should guide the management approach to minimize morbidity, mortality, and improve quality of life.
From the Research
Immediate Complications after Low Anterior Resection
The immediate complications after a low anterior resection can be severe and potentially life-threatening. Some of the most significant complications include:
- Anastomotic leakage: This is one of the most common and serious complications after low anterior resection, with a frequency ranging from 0%-17% 2, 3, 4.
- Increased drainage, prolonged ileus, abdominal pain, fever, and leucocytosis: These symptoms can indicate anastomotic leakage and should be closely monitored 2, 5.
- Major morbidity and mortality: If left untreated, anastomotic leakage can lead to severe consequences, including death 2, 3.
Risk Factors for Anastomotic Leakage
Several risk factors can increase the likelihood of anastomotic leakage after low anterior resection, including:
- Male gender: Studies have shown that male patients are at a higher risk of anastomotic leakage 3.
- Side-to-end/J pouch-to-end anastomosis: This type of anastomosis has been associated with a higher risk of leakage 3.
- Preoperative radiotherapy: Patients who receive preoperative radiotherapy may be at a higher risk of anastomotic leakage 2.
Detection and Treatment of Anastomotic Leakage
Early detection and treatment of anastomotic leakage are crucial to prevent major morbidity and mortality. Some methods for detecting anastomotic leakage include:
- Intraperitoneal microdialysis: This technique can detect changes in lactate levels, which can indicate anastomotic leakage 5.
- Clinical scoring systems: These systems can help identify patients at risk of anastomotic leakage based on symptoms such as increased drainage, prolonged ileus, and abdominal pain 5.
- Surgical management: In cases of generalized leakage, surgical management is often the best course of treatment 3.