We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Invited Critique |

Anastomotic Leak Testing After Colorectal Resection—Invited Critique

Walter E. Longo, MD
Arch Surg. 2009;144(5):411-412. doi:10.1001/archsurg.2009.72.
Text Size: A A A
Published online


An anastomotic leak following restoration of intestinal continuity is one of the most dreaded complications following gastrointestinal tract surgery. Disruption of the colorectal anastomosis is a difficult complication that leads to significant morbidity and, at times, death. Since the inception of intestinal anastomoses, surgeons have looked for various methods to try and predict its occurrence prior to the patient's leaving the operating room. Several techniques have evolved to comfort the surgeon that his or her anastomosis is secure from disruption, but mostly center on integrating the anastomosis with an isotonic sodium chloride solution, 10% povidone-iodine, or air insufflation. Although most surgeons today will rely on the instillation of air via the colonoscope to test the anastomosis, data supporting its use as a method of ensuring anastomotic integrity is, at best, inconclusive. This large study of left-sided colorectal anastomoses reveals that, indeed, anastomotic leak testing is beneficial and that an airtight anastomosis may be a reliable indicator of anastomotic integrity. Three very important conclusions are brought to the forefront. First, an airtight anastomosis does not guarantee that anastomotic disruption will not occur postoperatively. Second, primary repair of a colorectal anastomosis that does not subsequently leak on testing also does not guarantee a subsequent postoperative anastomotic leak. Third, these data seem to suggest that an initial positive anastomotic leak test that either repair with fecal diversion or resecting the initial anastomosis and performing a new colorectal anastomosis will offer the best chance of not encountering a postoperative leak. Although the data presented did not comment on details such as the circumferential nature of the initial leak, the percentage of the anastomosis that had to be primarily repaired (perhaps number of 3-0 silks used), or the preexisting comorbidities of these patients related to risk of an anastomotic leak, the data from this article proposes an algorithmic approach to the results of the intraoperative anastomotic leak testing following colorectal resection and directs the surgeon to the need to repair, re-resect, or divert.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

1 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles