**10.2 Surgical procedures**

Whenever there is a formal indication for surgical reintervention (open or laparoscopic approach) due to the detection of CAL in the postoperative period, the general principles that govern the procedure are: eradication vs. control of CAL; reduction of fecal contamination in the abdominal cavity, and prevention vs. treatment of abdominal compartment syndrome.

Laparoscopy can be attempted after minimal invasive surgery and can reduce surgical stress in patients allowing a definitive treatment [150]. Reoperation for sepsis control is rarely necessary for those patients who already have a diverting stoma at the time of the leak, especially in extraperitoneal anastomoses. In the other cases, the eradication vs. control of CAL generally can be achieved by anastomosis dismantling and terminal colostomy confection or diversion ileostomy, and drainage of the CAL site [151].

The reduction of fecal contamination, when it exists, is made by peritoneal cavity lavage.

Patients with anastomotic leakage that develop peritonitis and an accentuated third space have a risk of intra-abdominal hypertension. The increase in intra-abdominal pressure can provoke aggravation of organ dysfunction with the development of abdominal compartment syndrome (ACS). The prevention/ treatment of ACS must be thought out and planned hallways if intravesical pressure is greater than 20 mmHg or if there is a worsening of cardiorespiratory or renal function whenever an attempt is made to proceed with the closure of the abdominal wall during the surgery [152]. In those cases, wound dressing systems with subatmospheric pressure can be a good option [153].
