PERIOPERATIVE STANDARDS TO AVOID ANASTOMO TIC LEAKAGE

Anastomotic leakage is a major cause of morbidity and mortality in gas trointestinal surgery. Its incidence varies in the different segments of the GI tract being highest in the distal rectum. The rate of anasto motic leakages was reduced considerably within the last 20 years. Peri operative measures have contributed to this reduction in addition to i mprovements and standardization in operative technique. Perioperative nutrition, perioperative antibiotic prophylaxis and mechanical bowel p reparation are widely used in colorectal surgery. Therefore they can b e considered as standards. High-caloric parenteral feeding is used com monly perioperative. Its efficiency to reduce postoperative septic com plications has been proven until now only for malnourished patients. T he aim of perioperative antibiotic prophylaxis is to reduce the bacter ial count after intraoperative contamination. Therefore tissue levels must be in the therapeutic range to cover for the expected bacteria. T he efficiency to reduce postoperative wound infection has been proven, however the influence on the rate of anastomotic leakages is still co ntroversial. Mechanical bowel preparation can reduce the bowel load bu t not bacterial concentration inside the bowel. Orthograde lavage with polyethylenglycol solution is feasable unless bowel obstruction is pr esent, but its influence on anastomotic healing is still under discuss ion. Although all of these procedures are widely used, their influence on anastomotic healing has still to be proven by prospective, control led trials.