The aim of this study was to determine by
univariate and multivariate analyses the factors associated with
clinically significant anastomotic leakage (AL) after large bowel
resection. From 1990 to 1997 a series of 707 patients underwent
colonic or rectal resection (without a stoma). Patients were divided
into two groups: those with clinical anastomotic leakage (group 1) and
those without it (group 2). AL occurred in 43 of 707 patients (6%).
The overall mortality was 2.2% and was significantly higher in
patients with AL than in those without: 5 of 43 (12%) versus 11 of 664
(1.6%), p <0.001. Univariate analysis showed 15
variables associated with the risk of AL: previous abdominal or pelvic
irradiation (p = 0.02), American Society of
Anesthesiologists (ASA) score > 2 (p = 0.04),
leukocytosis (p = 0.02), renal failure
(p = 0.03), steroid treatment (p =
0.01), duration of operation (p = 0.001),
intraoperative septic conditions (p = 0.006), total
colectomy (p = 0.009), transverse colectomy
(p = 0.02), difficulties encountered during
anastomosis (p = 0.001), ileorectal anastomosis
(p = 0.02), colocolic anastomosis (p
= 0.01), abdominal drainage (p = 0.05), and blood
transfusion intraoperatively (p = 0.006) and
postoperatively (p = 0.001). Multivariate analysis
showed that only preoperative leukocytosis (p = 0.04),
intraoperative septic conditions (p = 0.001),
difficulties encountered during anastomosis (p =
0.007), colocolic anastomosis (p = 0.004), and
postoperative blood transfusion (p = 0.0007) were
independent factors associated with AL. The risk of AL increased from a
range of 12% to 30% if one risk factor was present, to 38% with two
factors, to 50% with three factors. After colorectal resection and
intraperitoneal anastomosis, a temporary protective stoma is proposed
in selected patients with high risk factors for AL, as observed in our
study.