Rahbari reported a definition and grading scheme for anastomotic leak following anterior resection of the rectum. The authors are from multiple institutions from around the world and are members of the International Study Group for Rectal Cancer.
Patient selection: anterior resection of the rectum
NOTE: The paper includes references to over 50 definitions of anastomotic leak.
Definition of anastomotic leak - at least one of the following:
(1) both of the following
(1a) a communication between the intra- and extra-luminal compartments
(1b) associated with a defect of the integrity of the intestinal wall at the anastomosis (between colon and rectum OR between colon and anus)
(2) the presence of a pelvic abscess in proximity to the anastomosis implies an anastomotic leak (unless it can be explained by preoperative rupture).
This includes a leak from a neorectal reservoir (J-pouch, transverse coloplasty) at the suture or staple lines.
Grade
Features
A
radiologic leakage without clinical or laboratory findings; may have turbid or feculent contents from the drain
B
clinical findings require active therapeutic intervention without operative intervention; interventions may include antibiotics and/or interventional radiology
C
need for surgical re-operation; may be critically-ill and may be associated with considerable leakage at the anastomotic site
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