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Invited Critique
April 20, 2009

Contained Anastomotic Leaks After Colorectal Surgery—Invited Critique

Arch Surg. 2009;144(4):338. doi:10.1001/archsurg.2008.588

What constitutes a leak after colonic anastomoses and how often should it occur? These questions are answered in the article by Damrauer et al on this topic. Damrauer et al first offer a precise definition of a leak: leaks are “communications between the gastrointestinal lumen and the peritoneum at the anastomosis.” This definition is important to distinguish between fluid collections associated with leaks from abscesses that may form from bacterial contamination of the peritoneal cavity that is not associated with a leak. Failure to make this distinction has caused a wide variance in reported colonic anastomotic leak rates, ranging from 0.5% to 30%. True leaks are relatively uncommon. In this series of 4019 patients undergoing colon operations at a single institution between 1992 and 2004, the leak rate was 1.5%.

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