DOI: http://dx.doi.org/10.18203/2349-2902.isj20184218

A study of factors leading to post-operative leaks following bowel anastomosis

L. Srinivas, B. Venkatesh, Samir Ahmad

Abstract


Background: Intestinal anastomosis is one of the most commonly performed procedures, especially in the emergency setting and is also in the elective setting when resection is carried out for benign or malignant lesion of the gastrointestinal tract. Anastomotic leakage is a potentially disastrous complication, which can lead to sepsis and abdominal catastrophe. The aim of the study is to determine factors leading to post-operative leaks in gastrointestinal surgeries involving different kinds of anastomosis and to determine the role of parameters such as pre-operative hemoglobin, serum albumin, indication for surgery, degree of contamination, type of anastomosis, technical variations and postoperative management in anastomotic leaks. We also aim to determine the morbidity and mortality variation and to study the various presentations of anastomotic leak in the patient group as well.

Methods: A prospective study was conducted from December 2015 till the end of august 2017 at Prathima Institute of Medical Sciences, Karimnagar. All patients undergoing gastrointestinal anastomosis electively and as an emergency procedure were included in this study. The total number of cases studied is 60.

Results: Out of the 60 cases in this study, 49 cases were done electively, and 11 cases were done on an emergency basis. Anastomotic leaks occurred most in emergency cases (27.27%). Among 5 patients, (71.42%) leaks were managed conservatively and rest required intervention. There was increased death rate in patients with leak. Leaks occurred maximum in jejunoileal anastomosis. Most common organ involved was esophagus (28.57%).

Conclusions: Anastomotic leaks are a common complication following all types of gastrointestinal anastomosis. It is believed, hypoalbuminemia hinders anastomotic healing. Surgeries indicated in emergency situation carried increased risk of operative leaks in post-operative period.


Keywords


Anastomotic leak, Bowel anastomosis, Emergency, Elective, Hypoalbuminemia

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References


Kaidar-Person O, Rosenthal RJ, Wexner SD et al. Compression anastomosis: history and clinical considerations. Am J Surg. 2008;195(6):818-26.

Bruce J, Krukowski ZH, Al‐Khairy G, Russell EM, Park KG. Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg. 2001;88(9):1157-68.

Cheng YT, Ching CT, Chone CW. The risk factor of anastomotic leakage and influence of fecal diversion after resection of rectal cancer. J Soc Colon Rectal Surg. 2010;21(1):9-16.

Sultan R, Chawla T Zaidi M. Factors affecting anastomotic leak after colorectal anastomosis in patients without protective stoma in tertiary care hospital. J Pak Med Assoc. 2014;64(2):166-70.

Buchs NC, Gervaz P, Secic M, Bucher P, Mugnier-Konrad B, Morel P. Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study. Int J Colorectal Dis. 2008;23(3):265-70.

Hyman N, Manchester TL, Osler T, Burns B, Cataldo PA. Anastomotic leaks after intestinal anastomosis: it's later than you think. Ann Surg. 2007;245(2):254-8.

Trencheva K, Morrissey KP, Wells M, Mancuso CA, Lee SW, Sonoda T, et al. Identifying important predictors for anastomotic leak after colon and rectal resection: prospective study on 616 patients. Ann Surg. 2013;257(1):108-13.

Hyman N, Manchester TL, Osler T, Burns B, Cataldo PA. Anastomotic leaks after intestinal anastomosis: it's later than you think. Ann Surg. 2007;245(2):254.

Irvin TT, Goligher JC. Aetiology of disruption of intestinal anastomoses. Br J Surg. 1973;60(6):461-4.

Burke P, Mealy K, Gillen P, Joyce W, Traynor O, Hyland J. Requirement for bowel preparation in colorectal surgery. Br J Surg. 1994;81(6):907-10.

Choy PY, Bissett IP, Docherty JG, Parry BR, Merrie AE. Stapled versus handsewn methods for ileocolic anastomoses. Cochrane Database Syst Rev. 2007;3(3).

Lustosa SA, Matos D, Atallah AN, Castro AA. Stapled versus handsewn methods for colorectal anastomosis surgery. Cochrane Database Syst Rev. 2001;CD003144.

NasirKhan MU, Abir F, Longo W, Kozol R. Anastomotic disruption after large bowel resection. World J Gastroenterol: WJG. 2006;12(16):2497.

Vignali A, Fazio VW, Lavery IC, Milsom JW, Church JM, Hull TL, et al. Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1,014 patients. J Am Coll Surg. 1997;185(2):105-13.

Manson PN, Corman ML, Coller JA, Veidenheimer MC. Anastomotic recurrence after anterior resection for carcinoma: Lahey Clinic experience. Dis Colon Rectum. 1976;19(3):219-24.

Seshadri A. Clinical Factors Influencing Bowel Anastomotic Leak. Int J Biomed Res.2016;7(6):350-5.