Colorectal Anastomoses:Surgical outcome and prevention of anastomotic leakage

Colorectal surgery is a frequently performed procedure with more than 10.000 annual resections in the Netherlands. The majority of resections are performed for colorectal cancer. The first part of this thesis focused on outcome of colorectal cancer surgery in the Netherlands based on the nationwide data of the Dutch Surgical Colorectal Audit. Surgical resection with creation of bowel continuance is the primary goal in uncomplicated procedures. An anastomosis however, bears the risk of anastomotic leakage, the most feared postoperative complication. The occurrence of anastomotic leakage is associated with more postoperative re-interventions, high morbidity and even mortality. In order to prevent against anastomotic leakage and its sequelae a defunctioning stoma could be constructed, and in high risk patients avoidance of an anastomosis could be preferred by means of an end-colostomy. Construction of stomas have their own drawbacks including more postoperative complications, higher hospital re-admission rates and stoma care problems. The second part of the thesis focused on prevention of anastomotic leakage in stapled colorectal anastomoses. The C-seal is a biodegradable intraluminal drain, which is fixed to the proximal side of the anastomosis during the stapling procedure, hereby covering the newly made anastomosis and preventing leakage of intestinal contents. The randomized results of the C-seal trial did not show a leakage reducing effect of the C-seal in colorectal anastomoses. Therefore there seems to be no future role for the C-seal in clinical anastomotic leakage prevention in colorectal surgery