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complication but are associated with high morbidity and mortality. The surgeon must be familiar with the
clinical symptoms and diagnostic methods to detect and treat this complication early under the basic
principles: correct the anastomotic defect, prevent or treat sepsis, and provide adequate nutritional support.

Given the complexity and wide variation in the clinical presentation of ALs, there is currently no consensus
or clinical practice guidelines to direct the appropriate treatment for each patient. The current trend is away
from aggressive surgical management of ALs, limiting this option to cases of necrosis or uncontrolled sepsis.
On the contrary, the use of new minimally invasive management technologies, especially E-Vac and SEMS,
which have shown satisfactory results in the management of non-critical symptomatic cases, is increasing.

Currently, there are multiple clinical trials underway to identify and apply more robust intraoperative
preventive techniques, and new technologies for the minimally invasive management of ALs have been
introduced. Additional study results are expected in the next decade, and new devices for endoscopic
management of ALs, including hybrid devices (SEMS + E-Vac) and cell and gene therapies, may be adopted;
however, more preclinical and clinical trials assessing the safety and effectiveness of these therapies are
required.

DECLARATION
Authors’ contributions
Made substantial contributions to the concept, scope, literature review, writing, and revisions: Mittal SK,
Latorre-Rodriguez AR

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
Both authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2023.

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