INTRODUCTION: Very low colorectal anastomoses are considered to be more prone to complications than other anastomoses. We aimed to analyze possible risk factors for the surgically most relevant complication, anastomotic leakage. METHODS: Uni- and multivariate analysis of the relation between leakage and 18 patient- and procedure-dependent variables were performed in 98 patients after very low colorectal or coloanal anastomosis. RESULTS: In all, 18 patients developed a dehiscence. Two patients, both without a protective stoma, died because of the leakage (overall mortality 2%). From all analyzed variables, only smoking remained as an independent risk factor for anastomotic dehiscence. For all other parameters, such as protective stoma, experience of the surgeon, stage of tumor, radiation therapy, or the need for blood transfusions there was no significant correlation. CONCLUSIONS: From our study, a typical risk pattern for anastomotic dehiscence, with the exception of being a smoker, cannot be defined. Presumably, anastomotic leakage is being caused by a multitude of factors, such as a preexisting or intra-/postoperatively developing reduction of microperfusion, which have a strong influence but cannot be as readily evaluated as other parameters. Until this situation improves, protective stomata, which do not prevent leakage but attenuate the consequences, should be used regularly.
INTRODUCTION: Very low colorectal anastomoses are considered to be more prone to complications than other anastomoses. We aimed to analyze possible risk factors for the surgically most relevant complication, anastomotic leakage. METHODS: Uni- and multivariate analysis of the relation between leakage and 18 patient- and procedure-dependent variables were performed in 98 patients after very low colorectal or coloanal anastomosis. RESULTS: In all, 18 patients developed a dehiscence. Two patients, both without a protective stoma, died because of the leakage (overall mortality 2%). From all analyzed variables, only smoking remained as an independent risk factor for anastomotic dehiscence. For all other parameters, such as protective stoma, experience of the surgeon, stage of tumor, radiation therapy, or the need for blood transfusions there was no significant correlation. CONCLUSIONS: From our study, a typical risk pattern for anastomotic dehiscence, with the exception of being a smoker, cannot be defined. Presumably, anastomotic leakage is being caused by a multitude of factors, such as a preexisting or intra-/postoperatively developing reduction of microperfusion, which have a strong influence but cannot be as readily evaluated as other parameters. Until this situation improves, protective stomata, which do not prevent leakage but attenuate the consequences, should be used regularly.
Authors: Dominik S Schoeb; Christian D Klink; Andreas Lambertz; Roman Eickhoff; Daniel Busch; Tom F Ulmer; Ulf P Neumann; Marcel Binnebösel Journal: Int J Colorectal Dis Date: 2015-08-12 Impact factor: 2.571