DOI: http://dx.doi.org/10.18203/2349-2902.isj20211423

Factors affecting the outcome of intestinal anastomosis: a prospective study

Vishnu Shanker, Roop Kishan Kaul, Abhishek Singh Rathore

Abstract


Background: Anastomotic leak is one of the most dreaded complications after intestinal anastomosis. The prevalence of anastomotic leak is 0.5%-30% in literature and resulting mortality rate is 10%-15%. Various risk factors are known to be associated with it. This study was undertaken with the aim to identify and evaluate these predisposing factors.

Methods: A prospective study was conducted from March 2019 to February 2020 at Teerthankar Mahaveer medical college and research centre, Moradabad. All patients undergoing hand-sewn gastro-intestinal anastomosis electively as well as in emergency were included in this study. The total number of cases studied were 80.

Results: Post-operative anastomotic leaks were present in 10% and associated mortality was 100%. Increasing age was associated with leakage (p=0.02) and 75% patients with leaks were male. The following were observed to be significant risk factors associated with anastomotic dehiscence: diabetes mellitus (p=0.05), pallor (p=0.01), low haemoglobin (p=0.003), altered TLC count (p=0.008) low serum protein (p=0.001), albumin (p=0.001) longer operative time (p=0.02). Other predisposing factors like serum creatinine, hyperbilirubinema, elective/emergency surgeries, contamination of peritoneal cavity and time taken to perform the anastomosis were insignificant statistically.

Conclusions: This study identified and assessed the various risk factors associated with anastomotic leaks and found age, sex, anaemia, sepsis, hypoproteinemia, hypoalbuminemia, increased operative-time to be significant and we concluded that controlling these factors will help in minimizing the chances of anastomotic dehiscence.


Keywords


Anastomotic leak, Dehiscence, Intestinal anastomosis, Risk factors, Anaemia, Hypoalbuminemia

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References


Phillips B. Reducing gastrointestinal anastomotic leak rates: Review of challenges and solutions. Open Access Surg. 2016;2016:5.

Kar S, Mohapatra V, Singh S, Rath PK, Behera TR. Single layered versus double layered intestinal anastomosis: A randomized controlled trial. J Clin Diagnostic Res. 2017;11(6):PC01-4.

Jain SK, Vindal A. Principles of Intestinal Anastomosis. In: Carter SD, Russell R, Pitt HA, Jain SK, editors. Atlas of General Surgery. 4th editio. Jaypee Brothers Medical Publishers, Ltd/Hodder Arnold. 2011;290-7.

Nasirkhan MU, Abir F, Longo W, Kozol R. Anastomotic disruption after large bowel resection. World J Gastroenterol. 2006;12(16):2497-504.

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.

Shikata S, Yamagishi H, Taji Y, Shimada T, Noguchi Y. Single- versus two- layer intestinal anastomosis: A meta-analysis of randomized controlled trials. BMC Surg. 2006;6.

Chen C. The art of bowel anastomosis. Scand J Surg. 2012;101(4):238-40.

Travers B. An inquiry into the process of nature in repairing injuries of the intestines: illustrating the treatment of penetrating wounds and strangulated hernia [Internet]. Longman, Hurst, Rees, Orme, and Brown; London. 1812;471-7.

Halsted WS. Circular Suture of the Intestine-An Experimental Study. Am J Med Sci. 1887.

Saha AK, Tapping CR, Foley GT, Baker RP, Sagar PM, Burke DA et al. Morbidity and mortality after closure of loop ileostomy. Colorectal Dis. 2009;11(8):866-71.

Sørensen LT, Jørgensen T, Kirkeby LT, Skovdal J, Vennits B, Wille-Jørgensen P. Smoking and alcohol abuse are major risk factors for anastomotic leakage in colorectal surgery. Br J Surg. 1999;86(7):927-31.

Luján JJ, Németh ZH, Barratt-Stopper PA, Bustami R, Koshenkov VP, Rolandelli RH. Factors Influencing the Outcome of Intestinal Anastomosis. Am Surg. 2011;77(9):1169-75.

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.

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.

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

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.

Cooke DT, Lin GC, Lau CL, Zhang L, Si M-S, Lee J, et al. Analysis of cervical esophagogastric anastomotic leaks after transhiatal esophagectomy: risk factors, presentation, and detection. Ann Thorac Surg. 2009;88(1):175-7.

Hayden DM, Mora Pinzon MC, Francescatti AB, Saclarides TJ. Patient factors may predict anastomotic complications after rectal cancer surgery: Anastomotic complications in rectal cancer. Ann Med Surg. 2015;4(1):11-6.

Farghaly A, Ammar M, Algammal A, Arafa A. Risk factors for leak in emergent small bowel anastomosis. Menoufia Med J. 2019;32(2):574-80.

Sakr A, Emile SH, Abdallah E, Thabet W, Khafagy W. Predictive Factors for Small Intestinal and Colonic Anastomotic Leak: a Multivariate Analysis. Indian J Surg. 2017;79(6):555-62.

Jina A, Singh UC. Factors influencing intestinal anastomotic leak and their predictive value. Int Surg J. 2019;6(12):4495-501.

Yamamoto T, Allan RN, Keighley MRB. Risk factors for intra-abdominal sepsis after surgery in Crohn’s disease. Dis Colon Rectum. 2000;43(8):1141-5.

Mäkelä JT, Kiviniemi H, Laitinen S. Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis. Dis Colon Rectum. 2003;46(5):653-60.

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.

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. 2010;26(4):265-73.

Kawada K, Hasegawa S, Hida K, Hirai K, Okoshi K, Nomura A et al. Risk factors for anastomotic leakage after laparoscopic low anterior resection with DST anastomosis. Surg Endosc. 2014;28(10):2988-95.

Silva-Velazco J, Stocchi L, Costedio M, Gorgun E, Kessler H, Remzi FH. Is there anything we can modify among factors associated with morbidity following elective laparoscopic sigmoidectomy for diverticulitis? Surg Endosc. 2016;30(8):3541-51.