Risk factors for, and management of anastomotic leakage in rectal surgery.

Anastomotic leakage is one of the most serious early complications of any rectal anastomosis. Proximal defunctioning mitigates the consequences of leakage but does not abolish the risk. The lower the anastomosis the higher the risks of leakage. There is evidence that a short colon pouch reduces the risks of leakage. A high index of suspicion is required to detect the early non-specific signs of anastomotic leakage. Urgent surgical intervention is usually required to avert a life threatening situation. Reports of the demise of temporary defunctioning of the low anastomosis are premature, and judicious use of faecal diversion should never be regarded as surgical temerity.