I. Kanellos • K. Vasiliadis • S. Angelopoulos • T. Tsachalis M.G. Pramateftakis • I. Mantzoros • D. Betsis 4th Surgical Department Aristotle University, Thessaloniki, Greece I. Kanellos () Antheon 1, Panorama 55236 Thessaloniki, Greece E-mail: ik@hol.gr Introduction Anastomotic leakage is one of the most feared and life- threatening early complications following rectal anastomo- sis and continues to represent a major clinical problem. The reported clinical leakage rate after anterior resection of the rectum for rectal cancer varies from 3% to 21% and gener- ally results in an important increase of postoperative mor- bidity [1, 2]. The aim of this study is to present the incidence of anasto- motic leakage after anterior resection for rectal cancer and to demonstrate the therapeutic approach for the treatment of this complication. Patients and methods During the last ten years, 93 patients underwent anterior resec- tion of the rectum for rectal cancer. There were 53 males and 40 females, the average age being 66.7 years (range 43–88). Low anterior resection with total mesorectal excision (TME) was per- formed in 72 and high anterior resection in 21 patients. Low anterior resection was considered anastomosis of the colon to the extraperitoneal rectum. Tumour location was in the rectum in 87 and in the rectosigmoid junction in 6. All the patients under- went an elective operation after preoperative bowel irrigation one day prior to surgery. Antibiotic prophylaxis (1 g cefotaxim and 0.5 g metronidazole) was administrated at the time of induc- tion of anaesthesia. The surgical procedure started with a medi- an laparotomy in lithotomy position. The splenic flexure was taken down routinely in order to avoid any tension to the anas- tomosis. In patients with rectal cancer of the middle or lower third of the rectum the mesorectal was routinely totally excised, down to the pelvic floor. Thirteen anastomoses were handsewn (14%) and were fashioned using the interrupted serosubmucosal technique whereas 80 (86%) anastomoses were performed using a circular stapler of appropriate size. The integrity of the anas- tomoses was tested by betadine solution injected through the rectum. The procedure was followed by an insertion of easy- flow drainage into the small pelvis. Additionally, low anterior I. Kanellos • K. Vasiliadis • S. Angelopoulos • T. Tsachalis • M.G. Pramateftakis • I. Mantzoros • D. Betsis Anastomotic leakage following anterior resection for rectal cancer Abstract Background The aim of this study is to present the incidence of anastomotic leakage after anterior resection for rectal cancer and to demonstrate the therapeutic approach for the treatment of this complication. Patients and methods During the last ten years, 93 patients under- went anterior resection of the rectum for rectal cancer. Low anterior resection with total mesorectal excision (TME) was performed in 72, and high anterior resection in 21 patients. The definition of the anastomotic leakage was based on clin- ical features, peripheral blood investigations and abdominal CT scan. Results Clinically apparent anastomotic leakage developed in 9 patients (9.7%). Four patients were managed conservatively and five operatively. Postoperative mortality among the patients with anastomotic leakage was not recorded. Conclusions The incidence of anastomotic leak- age after anterior resection of the rectum for rectal cancer is relatively low. It remains however the most serious compli- cation following rectal resection for cancer. Key words Rectal cancer • Anterior resection • Anastomotic leakage Tech Coloproctol (2004) 8:S79–S81 DOI 10.1007/s10151-004-0119-8