Evaluation of risk factors for early complications following bowel anastomosis
DOI:
https://doi.org/10.18203/2349-2902.isj20254323Keywords:
Bowel anastomosis, Early complications, Risk factorsAbstract
Background: In emergency as well as in elective situations, gastrointestinal anastomosis is an essential step to maintain the continuity of gastrointestinal tract following intestinal resection. Anastomotic complications, primarily, anastomotic leaks is one of the most widely feared and extensively studied problems in GI surgery. That’s why this study was conducted to identify the risk factors for early complications in gastrointestinal anastomosis
Methods: This was a cross sectional observational Study which took place in the department of Surgery, Rangpur Medical College Hospital and private hospitals in Rangpur, Bangladesh from 1st October 2018 to 31st March 2019 over a period of 6 months. All statistical analysis was performed using the SPPS software program version 26.0 (SPSS, Inc., Chicago, IL, United States of America). A p value<0.05 was considered statistically significant.
Results: A total number of 200 patients were included in the study by purposive sampling method. Mean age of the study population was 46±13.6 years with a male female ratio of 2:1. Among them 44% patients had gastro-jejunal anastomosis and 66% patients had anastomosis involving small and large gut. Anastomotic leaks (AL), (4.5%) and hemorrhage (2.2%) were the main post-operative complications. Re-operation was required in 3.5% patients. Operative mortality rate was 5.5%, with 06 deaths (54%) secondary to anastomotic complications. Univariate analysis of the overall population male patient, age, malnutrition, malignancy, sepsis and uses of steroids were independent predictors of postoperative complication following gastrointestinal anastomosis.
Conclusions: Anastomotic complications, particularly anastomotic leaks, remain a major unsolved problem in GI surgery.
Metrics
References
Daams F, Luyer M, Lange JF. Colorectal anastomotic leakage: aspects of prevention, detection and treatment. World J Gastroenterol. 2013;19(15):2293–7 DOI: https://doi.org/10.3748/wjg.v19.i15.2293
Collaborative EESA. ESCP Safe Anastomosis ProGramme in CoLorectal SurgEry (EAGLE): Study protocol for an international cluster randomised trial of a quality improvement intervention to reduce anastomotic leak following right colectomy. Colorectal Dis. 2021;23(10):2761–71. DOI: https://doi.org/10.1111/codi.15806
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. DOI: https://doi.org/10.1007/s00384-007-0399-3
Krarup PM, Nordholm-Carstensen A, Jorgensen LN, Harling H. Anastomotic leak increases distant recurrence and long-term mortality after curative resection for colonic cancer: a nationwide cohort study. Ann Surg. 2014;259(5):930–8. DOI: https://doi.org/10.1097/SLA.0b013e3182a6f2fc
Turrentine FE, Denlinger CE, Simpson VB, Garwood RA, Guerlain S, Agrawal A, et al. Morbidity, mortality, cost and survival estimates of gastrointestinal anastomotic leaks. J Am Coll Surg. 2015;220(2):195–206. DOI: https://doi.org/10.1016/j.jamcollsurg.2014.11.002
Brown SR, Mathew R, Keding A, Marshall HC, Brown JM, Jayne DG. The impact of postoperative complications on long-term quality of life after curative colorectal cancer surgery. Ann Surg. 2014;259(5):916–23. DOI: https://doi.org/10.1097/SLA.0000000000000407
Kube R, Mroczkowski P, Granowski D, Benedix F, Sahm M, Schmidt U, et al. Anastomotic leakage after colon cancer surgery: a predictor of significant morbidity and hospital mortality and diminished tumour-free survival. Eur J Surg Oncol. 2010;36(2):120–4. DOI: https://doi.org/10.1016/j.ejso.2009.08.011
Ozmen I, Grupa VEM, Bedrikovetski S, Dudi-Venkata NN, Huisman DE, Reudink M, et al. Risk Nomogram Does Not Predict Anastomotic Leakage After Colon Surgery Accurately: Results of the Multi-center LekCheck Study. J Gastrointest Surg. 2022;26(4):900–10. DOI: https://doi.org/10.1007/s11605-021-05119-6
Hedrick TL, Kane W. Management of Acute Anastomotic Leaks. Clin Colon Rectal Surg. 2021;34(6):400–5. DOI: https://doi.org/10.1055/s-0041-1735271
Dias VE, Castro P, Padilha HT, Pillar LV, Godinho LBR, Tinoco ACA, et al. Preoperative risk factors associated with anastomotic leakage after colectomy for colorectal cancer: a systematic review and meta-analysis. Rev Col Bras Cir. 2022;49:223-5. DOI: https://doi.org/10.1590/0100-6991e-20223363-en
Farrah JP, Lauer CW, Bray MS, McCartt JM, Chang MC, Meredith JW, et al. Stapled versus hand-sewn anastomoses in emergency general surgery: A retrospective review of outcomes in a unique patient population. J Trauma Acute Care Surg. 2013;74(5):1187-94. DOI: https://doi.org/10.1097/TA.0b013e31828cc9c4
Telem DA. Risk factors for anastomotic leak following colorectal surgery: a case-control study. Arch Surg. 2010;145(4):371. DOI: https://doi.org/10.1001/archsurg.2010.40
Yeung DE, Peterknecht E, Hajibandeh S. C-reactive protein can predict anastomotic leak in colorectal surgery: a systematic review and meta-analysis. Int J Colorectal Dis. 2021;36(6):1147–62. DOI: https://doi.org/10.1007/s00384-021-03854-5
Trencheva K, Morrissey KP, Wells M. Identifying important predictors for anastomotic leak after colon and rectal resection: prospective study on 616 patients. Ann Surg. 2013;257:108–13. DOI: https://doi.org/10.1097/SLA.0b013e318262a6cd
Choudhuri AH, Uppal R, Kumar M. Influence of non-surgical risk factors on anastomotic leakage after major gastrointestinal surgery: audit form a tertiary care teaching institute. Int J Crit Illn Inj Sci. 2013;3(4):246–9. DOI: https://doi.org/10.4103/2229-5151.124117
McDermott ED, Heeney A, Kelly ME. Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. BJS. 2015;102:462–79. DOI: https://doi.org/10.1002/bjs.9697
Makela J, Kiviniemi HK, Laitinen S. Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis. Dis Colon Rectum. 2013;46(5):653–60. DOI: https://doi.org/10.1007/s10350-004-6627-9
Fielding LP, Stewart-Brown S, Blesovsky L, Kearney G. Anastomotic integrity after operations for large-bowel cancer: a multicenter study. Br Med J. 2020;281:411-4. DOI: https://doi.org/10.1136/bmj.281.6237.411
Chassin JL, Rifkind KM, Sussman B. The stapled gastrointestinal tract anastomosis: incidence of postoperative complications compared with the sutured anastomosis. Ann Surg. 2018;188:689-96. DOI: https://doi.org/10.1097/00000658-197811000-00019
Parthasarathy M, Greensmith M, Bowers D. Risk factors for anastomotic leakage after colorectal resection: a retrospective analysis of 17518 patients. Colorectal Dis. 2016;19:288–98. DOI: https://doi.org/10.1111/codi.13476
Frye J, Bokey EL, Chapuis PH. Anastomotic leakage after resection of colorectal cancer generates prodigious use of hospital resources. Colorectal Dis. 2019;11:917–20. DOI: https://doi.org/10.1111/j.1463-1318.2008.01728.x
Anandan PK, Hassan MMN, Mathew M. Pre-operative hypoalbuminemia is a major risk factor for anastomotic leak in emergency gastrointestinal resection and anastomosis. Int Surg J. 2017;4:1405-8. DOI: https://doi.org/10.18203/2349-2902.isj20171151
Choi DH, Hwang JK, Ko YT, Jang HJ, Shin HK, Lee YC, et al. Risk Factors for Anastomotic Leakage after Laparoscopic Rectal Resection. J. Korean Soc. Coloproctol. 2020;26:265–73. DOI: https://doi.org/10.3393/jksc.2010.26.4.265
Slieker JC, Komen N, Mannaerts GH, Karsten TM, Willemsen P, Murawska M, et al. Long-Term and Perioperative Corticosteroids in Anastomotic Leakage: A Prospective Study of 259 Left-Sided Colorectal Anastomoses: A Prospective Study. Arch Surg. 2022;147:447–52. DOI: https://doi.org/10.1001/archsurg.2011.1690
Zarnescu EC, Zarnescu NO, Costea R. Updates of Risk Factors for Anastomotic Leakage after Colorectal Surgery. Diagnostics. 2021;11:2382. DOI: https://doi.org/10.3390/diagnostics11122382