Management and outcome of colorectal anastomotic leaks
Adult
Aged, 80 and over
Male
Time Factors
Colon
Anastomosis, Surgical
Rectum
Surgical Stomas
Anastomotic Leak
Middle Aged
3. Good health
03 medical and health sciences
Treatment Outcome
0302 clinical medicine
Health Resources
Humans
Female
Aged
DOI:
10.1007/s00384-010-1094-3
Publication Date:
2010-11-24T04:55:52Z
AUTHORS (7)
ABSTRACT
Anastomotic leak is a devastating complication of an intestinal anastomosis. Optimal management and outcome is not routinely described, and much of our knowledge relies upon historical data. We wished to examine the management and outcome of anastomotic leaks on a colorectal surgery unit in the twenty-first century.A retrospective audit of all patients who had a colorectal anastomotic leak between January 2002 and December 2008 in a large university teaching hospital. Data collected included patient characteristics, primary diagnosis, mode of diagnosis and time to diagnosis of anastomotic leak, inpatient management, morbidity and mortality, permanent stoma rate, use of hospital resources.Thirty patients (16 male, 14 female), with a median age of 60 years (range 25-84 years), had an anastomotic leak. The median time to presentation of clinically suspected leaks was 12 days (range 3-56 days). Fourteen patients required reoperation, with ten needing the anastomosis take down. Average hospital stay was 40 days. The permanent stoma rate following a rectal anastomotic leak was 27% and 57.1% from a colonic leak. Overall mortality in this series was 27%. Mortality was higher after leak from a colonic anastomosis than after leak from a rectal anastomosis (43.8% vs. 7.1%, respectively).Anastomotic leaks are not detected until late in the post-operative period and are associated with a high mortality. Demand on hospital resources is high. In this series, patients who leaked after a colonic anastomosis had a higher mortality and permanent stoma rate than after leaks from a rectal anastomosis.
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