The formation of granulation tissue is also essential during normal wound healing, which includes fibrovascular tissue containing fibroblasts, collagen, and blood vessels. The serosa seems to be important in providing a matrix for fibroblasts, while the interaction between bacteria, mucus and the mucosal layer also seem important to maintain homeostasis in which anastomotic healing can occur. However, the role of the other layers should not be neglected, since they are also essential during the wound healing process. Therefore, the highest risk for AL is during the first few days after surgery for healthy patients. After approximately four weeks post-op, the reorganization of collagen is almost finished, and the wound healing is about 90% complete. After five days, the new tissue has already gained the strength and resilience of surrounding healthy tissue. Within the first three to four days after gastrointestinal surgery, fibroblasts from the submucosa become active and start to deposit collagen. Among these four layers, the submucosa, consisting mainly of collagen and elastin fibers, has historically been the most important layer in wound healing as it is the layer with the highest tensile strength. The bowel wall of the colon consists of four layers, i.e., the mucosa, submucosa, muscularis propria, and serosa. It should be noted that wound healing in the gastrointestinal tract is different from that of cutaneous healing and is not yet fully understood. Therefore, AL is likely to occur when anastomotic healing is disrupted, even if the surgical procedure was conducted without flaws. Wound healing also plays a major role in a successful anastomosis. This can increase the need for reoperation, risk of local recurrence, increase morbidity and mortality, and can generally have a greater impact on the quality of life. In the case that the luminal contents were to leak out into the abdominal area, patients could experience fever, abscess, septicemia, metabolic disturbances, or multiple organ failure. Colonic anastomotic leak is defined as a “leak of luminal contents from a surgical join between two hollow viscera”. While, in historic studies, leak rates of up to 30% were reported, more recent studies have suggested rates under 3%. Following operations involving colonic resection, an artificial connection must be made through a procedure called anastomosis, which can lead to anastomotic dehiscence or AL, which has been reported in the literature to occur with varying rates depending on the type, technique, and site of surgery among others ( Table 1). One of the deadliest complications of these surgeries is anastomotic leakage (AL), a major cause of postoperative mortality and morbidity. ![]() In the past, open colectomy was considered to be the cornerstone operation, however, in recent years, less invasive laparoscopic colectomy has become more popular. These conditions may include cancer, bowel obstructions, diverticulitis, and Crohn’s disease. A colectomy, or a colon resection, is a surgical procedure to remove all or part of the large intestine to treat or prevent diseases and conditions that affect the colon.
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