Advertisement

Indian Journal of Surgery

, Volume 79, Issue 6, pp 555–562 | Cite as

Predictive Factors for Small Intestinal and Colonic Anastomotic Leak: a Multivariate Analysis

  • Ahmad SakrEmail author
  • Sameh Hany Emile
  • Emad Abdallah
  • Waleed Thabet
  • Wael Khafagy
Original Article

Abstract

Anastomotic leak (AL) is a serious complication of intestinal surgery with various predisposing factors. This study aims to assess several risk factors associated with AL after small intestinal and colonic anastomoses through a multivariate analysis. Two hundred twenty-four patients (126 males) with intestinal anastomosis of a median age of 44 years were reviewed. Independent factors associated with AL were male gender (OR = 2.59, P = 0.02), chronic liver disease (CLD) (OR = 8.03, P < 0.0001), more than one associated comorbidity (OR = 5.34, P = 0.017), anastomosis conducted as emergency (OR = 2.73, P = 0.012), colonic anastomosis (OR = 2.51, P = 0.017), preoperative leukocytosis (OR = 2.57, P = 0.015), and intraoperative blood transfusion (OR = 2.25, P = 0.037). Predicative factors significantly associated with AL were male gender, CLD, multiple comorbidities, emergent anastomoses, colonic anastomoses, preoperative leukocytosis, and intraoperative blood transfusion.

Keywords

Anastomotic leak Risk factors Multivariate analysis Colonic anastomosis 

Notes

Compliance with Ethical Standards

Ethical approval was obtained from the institutional review board of Mansoura Faculty of Medicine.

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Isbister WH (2001) Anastomotic leak in colorectal surgery: a single surgeon’s experience. ANZ J Surg 71(9):516–520CrossRefPubMedGoogle Scholar
  2. 2.
    Alves A, Panis Y, Trancart D, Regimbeau JM, Pocard M, Valleur P (2002) Factors associated with clinically significant anastomotic leakage after large bowel resection: multivariate analysis of 707 patients. World J Surg 26(4):499–502CrossRefPubMedGoogle Scholar
  3. 3.
    Konishi T, Watanabe T, Kishimoto J, Nagawa H (2006) Risk factors for anastomotic leakage after surgery for colorectal cancer. results of prospective surveillance 202(3):439–444Google Scholar
  4. 4.
    Buchs NC, Gervaz P, Secic M, Bucher P, Mugnier-Konrad B, Morel P (2008) Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study. Int J Color Dis 23(3):265–270CrossRefGoogle Scholar
  5. 5.
    Thornton M, Joshi H, Vimalachandran C, Heath R, Carter P, Gur U et al (2011) Management and outcome of colorectal anastomotic leaks. Int J Color Dis 26(3):313–320CrossRefGoogle Scholar
  6. 6.
    Lim M, Akhtar S, Sasapu K, Harris K, Burke D, Sagar P et al (2006) Clinical and subclinical leaks after low colorectal anastomosis:a clinicaland radiologic study. Dis Colon rectum 49(10):1611–1619CrossRefPubMedGoogle Scholar
  7. 7.
    Montagnana M, Minicozzi AM, Salvagno GL, Danese E, Cordiano C, De Manzoni G et al (2009) Postoperative variation of C-reactive protein and procalcitonin in patients with gastrointestinal cancer. Clin Lab 55(5–6):187–192PubMedGoogle Scholar
  8. 8.
    Moyes LH, Leitch EF, McKee RF, Anderson JH, Horgan PG, McMillan DC (2009) Preoperative systemic inflammation predicts postoperative infectious complications in patients undergoing curative resection for colorectal cancer. Br J Cancer 100(8):1236–1239CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Byrn JC, Schlager A, Divino CM, Weber KJ, Baril DT, Aufses AH Jr (2006) The management of 38 anastomotic leaks after 1,684intestinal resections. Dis Colon Rectum 49(9):1346–1353CrossRefPubMedGoogle Scholar
  10. 10.
    Morgenstern L, Yamakawa T, Ben-Shoshan M et al (1972) Anastomotic leakage after low colonic anastomosis. Am J Surg 123:104CrossRefPubMedGoogle Scholar
  11. 11.
    Schrock TR, Deveney CW, Dunphy JE (1973) Factors contributing to leakage of colonic anastomoses. Ann Surg 177:513CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Berry SM, Fischer JE (1996) Classification and pathophysiology of enterocutaneous fistulas. Surg Clin North Am 76(5):1009–1018CrossRefPubMedGoogle Scholar
  13. 13.
    Paun BC, Cassie S, MacLean AR, Dixon E, Buie WD (2010) Postoperative complications following surgery for rectal cancer. Ann Surg 251(5):807–818CrossRefPubMedGoogle Scholar
  14. 14.
    Gluszek S, Korczack M, Kot M, Matykiewicz J, Kozieł D (2011) Digestive system fistula: a problem still relevant today. Pol Przegl Chir 83(1):32–41PubMedGoogle Scholar
  15. 15.
    Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P et al (2011) Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 173(6):676–682CrossRefPubMedGoogle Scholar
  16. 16.
    Strickland GT (2006) Liver disease in Egypt: hepatitis C superseded schistosomiasis as a result of iatrogenic and biological factors. Hepatology 43(5):915–922CrossRefPubMedGoogle Scholar
  17. 17.
    Demetriades D, Murray JA, Chan LS, Ordonez C, Bowley D, Nagy KK et al (2002) Handsewn versus stapled anastomosis in penetrating colon injuries requiring resection: a multicenter study. J Trauma 52(1):117–121PubMedGoogle Scholar
  18. 18.
    Choy PY, Bissett IP, Docherty JG, Parry BR, Merrie A, Fitzgerald A (2011) Stapled versus handsewn methods for ileocolic anastomoses. Cochrane Database Syst Rev 9:CD004320Google Scholar
  19. 19.
    Choi HK, Law WL, Ho JW (2006) Leakage after resection and intraperitoneal anastomosis for colorectal malignancy: analysis of risk factors. Dis Colon Rectum 49(11):1719–1725CrossRefPubMedGoogle Scholar
  20. 20.
    Choudhuri AH, Uppal R, Kumar M (2013) Influence of non-surgical risk factors on anastomotic leakage after major gastrointestinal surgery: audit from a tertiary care teaching institute. Int J Crit Illn Inj Sci 3(4):246–249. doi: 10.4103/2229-5151.124117 CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Lustosa SA, Matos D, Atallah AN, Castro AA (2001) Stapled versus handsewn methods for colorectal anastomosis surgery. Cochrane Database Syst Rev 3:CD003144Google Scholar
  22. 22.
    Khan RAA, Hameed F, Ahmed B, Dilawaiz M, Akram M (2010) Intestinal anastomosis: comparative evaluation for safety, cost effectiveness morbidity and complication of single versus double layer. Professional Med J 17(2):232–234Google Scholar
  23. 23.
    Shikata S, Yamagishi H, Taji Y, Shimada T, Noguchi Y (2006) Single versus two- layer intestinal anastomosis: a meta-analysis of randomized controlled trials. BMC Surg 6:2CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Demetriades D, Murray JA, Chan L et al (2001) Penetrating colon injuries requiring resection: diversion or primary anastomosis? An AAST prospective multicenter study. J Trauma 50(5):765–775CrossRefPubMedGoogle Scholar
  25. 25.
    Kirchhoff P, Dincler S, Buchmann P (2008) A multivariate analysis of potential risk factors for intra- and postoperative complications in 1316 elective laparoscopic colorectal procedures. Ann Surg 248:259–265CrossRefPubMedGoogle Scholar
  26. 26.
    Choi DH, Hwang JK, Ko YT et al (2010) Risk factors for anastomotic leakage after laparoscopic rectal resection. J Korean Soc Coloproctol 26(4):265–273. doi: 10.3393/jksc.2010.26.4.265 CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Petrowsky H, Demartines N, Rousson V, Clavien P (2004) A evidence-based value of prophylactic drainage in gastrointestinal surgery: a systematic review and meta-analyses. Ann Surg 24061074:1084Google Scholar
  28. 28.
    Draus JM Jr, Huss SA, Harty NJ, Cheadle WG, Larson GM (2006) Enterocutaneous fistula: are treatments improving? Surgery 140(4):570–576CrossRefPubMedGoogle Scholar
  29. 29.
    Haffejee AA (2004) Surgical management of high output enterocutaneous fistulae: a 24-year experience. Curr Opin Clin Nutr Metab Care 7(3):309–316CrossRefPubMedGoogle Scholar
  30. 30.
    Tan WP, Talbott VA, Leong QQ, Isenberg GA, Goldstein SD (2013) American Society of Anesthesiologists class and Charlson’s comorbidity index as predictors of postoperative colorectal anastomotic leak: a single institution experience. J Surg Res 184(1):115–119CrossRefPubMedGoogle Scholar

Copyright information

© Association of Surgeons of India 2016

Authors and Affiliations

  • Ahmad Sakr
    • 1
    Email author
  • Sameh Hany Emile
    • 1
  • Emad Abdallah
    • 1
  • Waleed Thabet
    • 1
  • Wael Khafagy
    • 1
  1. 1.Department General surgery, Faculty of MedicineMansoura University HospitalsMansoura cityEgypt

Personalised recommendations