Table 1.

Consequences of anastomotic leak

Hospital: ↑Length of hospital stay (two to three times) ↑Demand on critical care ↑Requirement for diagnostic (e.g. radiological) and therapeutic interventions (e.g. antibiotics, surgery) Damage to institutional reputation for surgical outcomes

Surgical: ↑Need for reoperations ↑Unintended stoma formation (in many cases permanent) ↑Readmission rate (the most common cause after colorectal surgery) ↑Mortality (double or more when compared to patients who do not develop AL)

Oncologic: Delayed postoperative adjuvant therapy ↑Risk of local recurrence ↑Risk of distant metastasis ↓Long-term cancer-specific survival

Medical: ↑Risk of abdominal (e.g. peritonitis) and systemic (e.g. pneumonia) septic complications ↑Risk for paralytic ileus (leading to delayed oral intake) ↑Risk of complications associated with delayed mobilisation (e.g. DVT) ↑Risks for anaesthesia

Physiological and psychosocial: ↑Requirement for TPN Long-term impaired bowel function (change in bowel movement, stool control)Impaired pelvic organ functions (e.g. from adhesions, or fibrosis in the area after local abscess) ↓Quality of life ↑Psychological and social stress

Immunological: Changes in gut microbiome and its functions

Financial: ↑Costs to hospital (two- to three-fold in the short term; long-term postoperative care costs also increase)