Determination of Two Specific Risk Factors in Maturation and Function of Anastomoses after Large Bowel Resection in Adults

Leakage of anastomoses is a feared and serious complication of colorectal surgery, as it greatly increases the morbidity and mortality. The frequency of anastomotic leakage is high in certain circumstances, such as emergency colorectal surgery, resection of low rectal tumours, presence of underlying chronic pathology of the colon, immunosuppression and malnutrition. However, despite proper caution and excellent surgical technique in colo-rectal resection, some anastomotic leaks are inevitable. Proximal diversion should be considered for patients with various factors hazardous to the anastomotic safety. This report seeks to highlight the importance of two special risk factors in adult anastomotic healing and function, the colonic and rectal neuronal malformations or innervation defects, and the impaired immune defense. Malformations of intestinal innervation are potentially associated with colonic motility disturbances, either accompanied by megacolon or not, rarely presented acutely. A definite diagnosis requires histopathological analysis of full-thickness intestinal biopsies, and the treatment should be tailored to the severity and extent of the possible neuronal defect. On the other hand, intestine-derived bacteria are implicated in causing systemic infection when the host defense mechanisms are compromised, and they could play a key causative role in the pathogenesis of anastomotic leak. Surgeons have to weigh the risk in specific circumstances with suspected immune defense disturbance and perform an ostomy instead of an anastomosis after colon resection.