Key Concepts

• Mechanical bowel prep and oral antibiotics prior to colon resection are associated with a lower risk of anastomotic leak.
• A significant proportion of anastomotic leaks present after the immediate postoperative period, especially if there is a history of pelvic radiation.
• Most early anastomotic bleeds are self-limited; late bleeds may be a sign of anastomotic leak.
• Anastomotic stricture after cancer resection should undergo endoscopic biopsy and imaging to rule out recurrent cancer.
• Benign anastomotic strictures may be amenable to endoscopic management, but some will require surgical revision or completion proctectomy with permanent colostomy if the strictured anastomosis is in the pelvis.
• Anastomotic complications often lead to significant detriments to quality of life with regard to pain, defecatory function, sexual function, and urinary function. Discussion of these issues with patients is critical for surgical decision-making.