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Source created 2026-08-24 · updated 2026-08-24
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ASCRS Ch10 — Anastomotic Complications

Citation: Friel CM, Kin CJ. "Anastomotic Complications." In: Steele SR, et al. (eds.), The ASCRS Textbook of Colon and Rectal Surgery, 4th ed. Springer Nature Switzerland AG; 2022. pp. 189–206 (PDF pp. 200–218 of the combined textbook file). Source file: raw/ASCRS Textbook 4th Ed.pdf (full 1,198-page textbook; cite by page range within the single PDF). Final chapter of Part I ("Perioperative/Endoscopy") — Part II ("Anorectal Disease") begins with Chapter 11.

Type: Specialty textbook chapter (reference/background, not primary literature).

Scope

Tenth chapter of the sequential full-textbook ingest (see ASCRS Ch01 - Anatomy and Embryology for the ingest's scope/plan) — the dedicated leak-focused companion chapter that both General Postoperative Complications (ASCRS Ch8) and Anastomotic Construction (ASCRS Ch9) explicitly deferred their own leak discussions to. Covers anastomotic leak (risk factors, diagnosis incl. CRP/procalcitonin biomarker cutoffs, management algorithm, chronic presacral sinus tracts, newer endoscopic salvage techniques), outcomes after leak (mortality, oncologic outcomes, permanent ostomy risk, functional/QoL/sexual/urinary effects), anastomotic fistula, blind loop syndrome, anastomotic bleeding, and anastomotic stricture (diagnosis, endoscopic and surgical treatment options).

Key content

This chapter's content was used to substantially rewrite and extend the existing Colorectal Anastomotic Complications page in place, rather than creating a duplicate new page — the clearest example yet in this ingest of the "reconcile, don't duplicate" pattern flagged as pending by two prior chapters. Nearly every section of that page was extended with quantified data (risk factors, biomarker-based diagnosis, timing) or entirely new subsections (outcomes after leak, anastomotic fistula, blind loop syndrome). Reciprocal cross-links were also added to Enhanced Recovery After Surgery (ERAS) (biomarker-driven leak surveillance relevant to early-discharge protocols) and Low Anterior Resection Syndrome (LARS) (leak-induced pelvic fibrosis as a plausible LARS mechanism).

Limitations

  • Textbook chapter, not primary literature; most figures (biomarker cutoffs, dilation/revision success rates, mortality/survival percentages) are drawn from cited studies the chapter authors summarize, not independently verified against the primary sources.
  • The emerging microbiome-anastomotic-leak research (specific bacterial strains/collagenase mechanisms) is presented as an active, rapidly evolving area — not a settled finding.
  • Success-rate data for surgical stricture revision comes from a heterogeneous literature that isn't limited to strictures alone (also includes fistulas and recurrent cancer in re-do pelvic surgery series), a limitation the chapter itself acknowledges.

Relevance

Tenth entry in the ASCRS ingest, and structurally the most significant chapter so far for this wiki's existing content — rather than creating a new page, it triggered the largest single-page rewrite of the ingest to date on Colorectal Anastomotic Complications, closing a gap explicitly flagged as pending since Ch8. Also closes out Part I of the ASCRS textbook ("Perioperative/ Endoscopy"); Chapter 11 begins Part II ("Anorectal Disease") with Hemorrhoids.