**9.5 Surgery**

The consensual definition of CAL detected by **laparoscopy** or **laparotomy** includes typical intra-operative findings, such as necrosis of the anastomosis, necrosis of the blind loop, dehiscence of the anastomosis, and signs of peritonitis. Laparoscopy is a valid and effective approach for treating complications following primary laparoscopic colorectal surgery [146]. Similarly, Rotholtz et al. concluded that early **redo-laparoscopy** (within 48 hours after the suspicion of a complication) provides higher chances for the use of a laparoscopic approach for management, providing a higher probability of good postoperative outcomes (**Figure 1d**), despite a greater risk of negative findings in the re-operation [147].

#### **Figure 1.**

*CT scan images of anastomotic leaks in colorectal surgery: (a) male, 68 years old, with a complete intestinal obstruction due to Crohn's disease. He was submitted to ileocecal resection by laparotomy. An anastomotic leak was detected on postoperative day 3. Treated with percutaneous drainage, antibiotic therapy, and total parenteral nutrition followed by exclusive enteral nutrition for 2 months. (b) Male, 67 years old, right colon cancer, submitted to right colectomy. Anastomotic leak detected on postoperative day 5. He was treated with percutaneous drainage, antibiotic therapy, and total parenteral nutrition. (c) Male, 85 years old, colon obstruction due to sigmoid carcinoma, submitted to laparoscopic sigmoidectomy. Anastomotic leak detected on postoperative day 5. He was treated with percutaneous, antibiotic therapy, and total parenteral nutrition during the ileus. (d) Female, 43 years old, locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy followed by low anterior rectal resection. Anastomotic leak detected on postoperative day 2. Re-laparoscopy on day 2 with manual suture reinforcement of the left side of the anastomosis, derivative ileostomy, antibiotic therapy, and total parenteral nutrition during the ileus. Ileostomy closure after adjuvant chemotherapy months later after low anterior resection.*
