Risk factors for anastomotic leakage after anterior resection of the rectum

Abstract

In this population based study, 12% of the patients had symptomatic anastomotic leakage after anterior resection of the rectum. Postoperative 30-day mortality was 2.1%. Low anastomosis, pre-operative radiation, presence of intra-operative adverse events and male gender were independent risk factors for symptomatic anastomotic leakage in the multivariate analysis. There was no difference in the use of temporary stoma in patients with or without anastomotic leakage.

Predicting Anastomotic Disruption after Emergent Small Bowel Surgery

“…This is more than numbers quoted in other studies, which are below 15% [2,3,4,5]. Our study group however consisted solely of emergency small bowel anastomoses.…”

“…Existing work on factors leading to anastomotic leaks has been in the form of retrospective studies. The leak rates in these studies have in general been below 15% but they have either focused on multiple levels of the gastrointestinal tract [2, 3] or colorectal anastomoses [4, 5]. We felt that the factors contributing to small bowel leakage in the emergent setting were distinctly different from those established by previous workers, who did not specifically address this subgroup of patients.…”

“…Though the majority of such work has been directed at the large bowel [4, 5], Golub et al [2] analyzed both small and large bowel anastomoses and found 5 independent factors predictive of anastomotic leak viz. chronic obstructive pulmonary disease, bowel obstruction, peritonitis, corticosteroid usage, blood transfusions >2 units and a serum albumin <3 g%.…”

“…Errors in anastomotic construction have traditionally been incriminated in these leaks [1], but various other causative factors have been shown to be of importance as well. These include bowel obstruction and peritonitis[2], advancing patient age [3], male gender [4], pre-operative radiation [4], intraoperative difficulties [4, 5], blood transfusions [2, 5],and level of anastomosis [5]. …”

Outcomes of Sphincter-Saving Operation for Rectal Cancer without Protective Stoma and Pelvic Drain, and Risk Factors for Anastomotic Leakage

“…Secondly, neoadjuvant chemoradiation, which has shown to be superior to adjuvant treatment in advanced rectal cancer [32], was seldom carried out in the present study because of our limited facility. Our findings suggested that neoadjuvant therapy was not a risk factor for anastomotic leakage whereas it was associated with a higher rate of leakage in other investigations [8, 33]. Further researches with a larger sample size are therefore required before a definite conclusion on these matters can be drawn.…”