A retrospective study of colostomies, leaks and strictures after colorectal anastomosis

Abstract

A review was undertaken of 360 patients undergoing elective left-sided colonic or rectal resections with primary anastomosis, under the care of one surgeon, over a nineteen year period. The incidence, aetiology and management of anastomotic leaks and strictures was studied and the role of proximal diverting colostomy considered. Perioperative mortality was 2.7%. The incidence of anastomotic leaks was 24.4%. Leaks were more common when anastomoses were low, were sutured or were constructed by trainees. Strictures developed in 5.8%. Local recurrence of tumour was the cause of 25% of these strictures. Anastomotic leakage was the principal cause of benign strictures; those developing in association with leaks were more likely to require surgical intervention. There was no evidence that delay in colostomy closure contributed to the development of benign anastomotic strictures. It was not possible to determine whether the presence of a colostomy affected the incidence of leaks but the local effects of such leaks were mitigated in patients with colostomies. Where a minor leak had occurred it was not necessary to wait for complete anastomotic healing before closing the colostomy. After major leaks, colostomy closure before complete healing was associated with further anastomotic problems in 16.0% of cases.

Quality Control of Colorectal Surgery with an Extensive Complication Registration System

“…In our documented material, all possible clinical subtypes are included and anastomotic leakage appeared in 22 of the 353 operated patients (6%). The mortality rate after colon surgery in our study (7%) is comparable with the figures published in the literature (3–18%) [1,2,3, 5, 13]. …”

“…The literature provides us, however, with a wide range of complication percentages. For example, the bowel leakage percentage ranges between 4 and 24% [3,4,5,6]. One can speculate that the reason for this wide range is explained by differences in the definition of a complication.…”

Analysis of Risk Factors and Management of Anastomotic Leakage After Rectal Cancer Surgery: An Indian Series

“…Some of the identified risk factors for anastomotic leakage are male gender, nutritional status, high BMI, the location of anastomosis, diverting stoma, and history of radiation [10][11][12][13]. Men, because of the narrow pelvis, offer greater challenge during pelvic dissection, and hence increased risk of anastomotic leakage [14].…”

Laparoskopik low anterior rezeksiyon sonrası oluşan anastomoz darlığında balon dilatasyon uygulaması: İki olgu sunumu

“…Kolonoskopun anastomozdan geçirilememesi veya klinik olarak hastada tıkanma semptomlarıyla birlikte radyolojik bulguların varlığı anastomoz striktürü olarak tanımlanır [3,4]. Benign anastomoz striktürleri kolonik anastomozlardan sonra %2-7 oranında görülürken [5,6], stapler yardımı ile yapılan kolorektal anastomozlarda bu oran %5 ile %22'ye kadar çıkar [7][8][9]. Anastomoz varlığı, hastaların pek çoğunda, endoskopik tedaviler ya da cerrahi tedaviye ihtiyaç gösteren ciddi klinik durumlara yol açmaktadır.…”