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Anastomotic leak in patients with acute complicated diverticulitis undergoing primary anastomosis: risk factors and the role of diverting loop ileostomy

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Abstract

Background

Recent data has suggested that primary anastomosis (PA), with or without a diverting loop ileostomy (DLI), is a safe option for the treatment of acute complicated diverticulitis. This study aimed to evaluate risk factors associated with anastomotic leak in patients who underwent a sigmoid colectomy with PA and to determine whether a DLI was protective against a clinically significant anastomotic leak.

Methods

Patients with acute complicated diverticulitis who underwent a laparoscopic or open sigmoid colectomy with PA, with or without a DLI, were identified in the NSQIP PUF(2016–2017). The rates of anastomotic leak, receipt of DLI, and type of leak management were compared. Multivariate logistic regression was performed.

Results

There were 497 patients identified. Seventy-nine(15.9%) patients had a DLI, while 418 (84.1%) did not. Twenty-six anastomotic leaks were identified (5.2%). On multivariate analysis, current smoking (OR 4.02; 95% CI 1.44–11.26) and chronic steroid use (OR 3.84; 95% CI 1.16–12.69) were significantly associated with an increased risk of leak. Of the 26 patients with anastomotic leaks, 5 (19.2%) had a DLI. There was no significant difference in the rate of leak between those with a DLI(5; 6.3%) and those without(21; 5.3%; p = 0.59). Patients who had a DLI were significantly less likely to experience an anastomotic leak requiring re-operation (p < 0.01).

Conclusions

Regardless of the presence of a DLI, chronic steroid use and smoking are associated with an increased risk of anastomotic leak in patients with acute complicated diverticulitis undergoing colectomy with PA. The presence of a diverting loop ileostomy is protective against re-operation.

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Authors and Affiliations

  1. Division of Colorectal Surgery, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA, 17822, USA

    Rebecca L. Hoffman, Hadassah Consuegra, Kevin Long & Christopher Buzas

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  1. Rebecca L. Hoffman
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  2. Hadassah Consuegra
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  3. Kevin Long
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Correspondence to Rebecca L. Hoffman.

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Hoffman, R.L., Consuegra, H., Long, K. et al. Anastomotic leak in patients with acute complicated diverticulitis undergoing primary anastomosis: risk factors and the role of diverting loop ileostomy. Int J Colorectal Dis 36, 1543–1550 (2021). https://doi.org/10.1007/s00384-021-03957-z

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  • DOI: https://doi.org/10.1007/s00384-021-03957-z

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