BACKGROUND: The ultimate fate of the leaking intestinal anastomosis is unknown. We sought to analyze long-term outcomes of anastomotic leak with an emphasis on identifying the likelihood of re-establishing intestinal continuity and the potential for releak with corrective surgery. METHODS: All consecutive subjects treated for clinical anastomotic leak from January 2001 through December 2007 were retrospectively reviewed. Patients were stratified by management of leak: (1) drainage alone, (2) proximal loop diversion, (3) repair/revision without diversion, (4) end stoma, or (5) tube enterostomy. We then determined management of anastomotic leak, mortality, corrective procedures, releak, and re-establishment of intestinal continuity. RESULTS: In a database of 2,627 intestinal procedures, 79 patients had 88 anastomotic leaks with a final overall mortality of 10.1%. The aggregate rate of re-establishment of intestinal continuity was lowest for the patients treated by end stoma (44.4%) as compared to other initial management options (p < 0.01). Of the patients who survived their initial anastomotic leak, 20.5% had another leak (releak). CONCLUSIONS: Patients who underwent resection of the leaking anastomosis and end stoma or proximal loop diversion have a high rate of long-term fecal diversion. The proportion of patients who experience an anastomotic releak is substantial following further corrective surgery to re-establish intestinal continuity.
BACKGROUND: The ultimate fate of the leaking intestinal anastomosis is unknown. We sought to analyze long-term outcomes of anastomotic leak with an emphasis on identifying the likelihood of re-establishing intestinal continuity and the potential for releak with corrective surgery. METHODS: All consecutive subjects treated for clinical anastomotic leak from January 2001 through December 2007 were retrospectively reviewed. Patients were stratified by management of leak: (1) drainage alone, (2) proximal loop diversion, (3) repair/revision without diversion, (4) end stoma, or (5) tube enterostomy. We then determined management of anastomotic leak, mortality, corrective procedures, releak, and re-establishment of intestinal continuity. RESULTS: In a database of 2,627 intestinal procedures, 79 patients had 88 anastomotic leaks with a final overall mortality of 10.1%. The aggregate rate of re-establishment of intestinal continuity was lowest for the patients treated by end stoma (44.4%) as compared to other initial management options (p < 0.01). Of the patients who survived their initial anastomotic leak, 20.5% had another leak (releak). CONCLUSIONS:Patients who underwent resection of the leaking anastomosis and end stoma or proximal loop diversion have a high rate of long-term fecal diversion. The proportion of patients who experience an anastomotic releak is substantial following further corrective surgery to re-establish intestinal continuity.
Authors: D Demetriades; J A Murray; L Chan; C Ordoñez; D Bowley; K K Nagy; E E Cornwell; G C Velmahos; N Muñoz; C Hatzitheofilou; C W Schwab; A Rodriguez; C Cornejo; K A Davis; N Namias; D H Wisner; R R Ivatury; E E Moore; J A Acosta; K I Maull; M H Thomason; D A Spain Journal: J Trauma Date: 2001-05
Authors: John C Byrn; Avraham Schlager; Celia M Divino; Kaare J Weber; Donald T Baril; Aurthur H Aufses Journal: Dis Colon Rectum Date: 2006-09 Impact factor: 4.585
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Authors: Robert A Burger; Mark F Brady; Michael A Bookman; Bradley J Monk; Joan L Walker; Howard D Homesley; Jeffrey Fowler; Benjamin E Greer; Matthew Boente; Gini F Fleming; Peter C Lim; Stephen C Rubin; Noriyuki Katsumata; Sharon X Liang Journal: J Clin Oncol Date: 2014-03-17 Impact factor: 44.544
Authors: Michael Thornton; Heman Joshi; Chandrakumar Vimalachandran; Richard Heath; Paul Carter; Ufuk Gur; Paul Rooney Journal: Int J Colorectal Dis Date: 2010-11-25 Impact factor: 2.571