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Purpose <p>Anastomotic leakage (AL) remains one of the most serious complications in colorectal surgery, with a&#xa0;substantial impact on morbidity, mortality, and long-term oncological outcomes. Although Hartmann’s procedure has traditionally been considered the standard approach for managing anastomotic failure, its limitations—particularly the high rates of permanent stoma formation and impaired quality of life—have driven the development of less invasive treatment strategies.</p> Methods <p>A&#xa0;comprehensive review of the literature was conducted to evaluate current concepts in the pathophysiology, diagnosis, and management of anastomotic leakage following colorectal surgery, with particular emphasis on minimally invasive and endoluminal treatment modalities.</p> Results <p>Contemporary evidence indicates a&#xa0;shift toward individualized, minimally invasive management strategies tailored to patient condition and leakage severity. Vacuum-assisted and hybrid endoluminal techniques, including vacuum-assisted closure therapy and VAC stent systems, have emerged as promising alternatives to traditional surgical approaches, demonstrating favorable outcomes in selected patients and a&#xa0;potential reduction in long-term morbidity.</p> Conclusion <p>This comprehensive review summarizes the current understanding of AL pathophysiology, diagnostic principles, and therapeutic strategies, with a&#xa0;special focus on the evolution of vacuum-assisted and hybrid endoluminal techniques such as the VAC stent. Optimal outcomes appear to depend on appropriate patient selection, early diagnosis, interdisciplinary collaboration between surgical and endoscopic teams, and the development of standardized treatment algorithms. Future efforts should focus on refining selection criteria, integrating multimodal expertise, and implementing perioperative optimization strategies.</p>

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Management of colorectal anastomotic leakage: from Hartmann’s procedure to modern endoluminal therapies

  • 期刊论文

  • 发表日期：

    2026年3月6日

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  • Peter Tschann,
  • Yannic Ammann,
  • Walter Brunner

摘要

Purpose

Anastomotic leakage (AL) remains one of the most serious complications in colorectal surgery, with a substantial impact on morbidity, mortality, and long-term oncological outcomes. Although Hartmann’s procedure has traditionally been considered the standard approach for managing anastomotic failure, its limitations—particularly the high rates of permanent stoma formation and impaired quality of life—have driven the development of less invasive treatment strategies.

Methods

A comprehensive review of the literature was conducted to evaluate current concepts in the pathophysiology, diagnosis, and management of anastomotic leakage following colorectal surgery, with particular emphasis on minimally invasive and endoluminal treatment modalities.

Results

Contemporary evidence indicates a shift toward individualized, minimally invasive management strategies tailored to patient condition and leakage severity. Vacuum-assisted and hybrid endoluminal techniques, including vacuum-assisted closure therapy and VAC stent systems, have emerged as promising alternatives to traditional surgical approaches, demonstrating favorable outcomes in selected patients and a potential reduction in long-term morbidity.

Conclusion

This comprehensive review summarizes the current understanding of AL pathophysiology, diagnostic principles, and therapeutic strategies, with a special focus on the evolution of vacuum-assisted and hybrid endoluminal techniques such as the VAC stent. Optimal outcomes appear to depend on appropriate patient selection, early diagnosis, interdisciplinary collaboration between surgical and endoscopic teams, and the development of standardized treatment algorithms. Future efforts should focus on refining selection criteria, integrating multimodal expertise, and implementing perioperative optimization strategies.