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Management of anastomotic complications of colorectal surgery

Robin Boushey, MD
Lara J Williams, MD, MSc, FRCSC
Section Editor
Martin Weiser, MD
Deputy Editor
Wenliang Chen, MD, PhD


The safety of colorectal surgery, as performed in patients with colorectal cancer and inflammatory bowel disease, has improved dramatically over the last 50 years due to improvements in preoperative preparation, antibiotic prophylaxis, surgical technique, and postoperative management [1]. Nevertheless, complications such as those related to colorectal anastomoses continue to occur. (See "Overview of the management of primary colon cancer" and "Overview of surgery for the treatment of primary rectal adenocarcinoma" and "Surgical management of ulcerative colitis".)

The risks, management, and outcomes of anastomotic complications of colorectal surgery will be reviewed here. These complications include bleeding, dehiscence and leakage, strictures, and fistulas [2]. The risks, management, and outcomes of intra-abdominal, pelvic, and genitourinary complications following colorectal surgery are reviewed elsewhere. (See "Management of intraabdominal, pelvic, and genitourinary complications of colorectal surgery".)


Colorectal surgery is associated with appreciable morbidity and mortality. Prospective studies, both multicenter and single center, have evaluated patient outcomes after colorectal surgery [3-9]. The rate of major morbidity ranged from 20 to 35 percent [4,7], and the 30-day mortality rate ranged from 2 to 9 percent [4-9]. There does not appear to be a significant difference in 30-day mortality rate between malignant versus benign indications for surgery [4,7,9].

Independent preoperative risk factors that are associated with an increased risk of in-hospital complications include [4,7]:

Age greater than 70 years


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Literature review current through: Sep 2016. | This topic last updated: Oct 9, 2016.
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