Leakage after Small Bowel Anastomosis A Retrospective Analysis of Risk Factors
Abstract
ABSTRACT
Background: Leakage from an anastomosis in the gastrointestinal tract is a serious complication that is often associated with increased morbidity, mortality and prolonged hospitalization. Anastomotic leak may be due to certain underlying risk factors which are recognized to affect alone or in combination.
Objective: To define factors associated with leakage of small bowel anastomosis and to find technique of small bowel anastomosis associated with lowest risk of anastomotic dehiscence.
Methods: A retrospective study was conducted at surgical ward, Al-Yarmouk Teaching Hospital, from Jan. 2012 to May. 2014. A total number of 82 cases which were classified into two groups on deferent bases, single layer extra mucosal interrupted anastomosis and double layer anastomosis. Clinical workup was reviewed to the risk factors responsible for anastomotic dehiscence including age, peritonitis, anemia, shock, uremia, malignancy and diabetes
Results: Eighty two patients were included in the study. Emergency operations were performed in 79 (96.3%) patients and elective operations were performed in 3(3.7%) patients. Peritonitis was identified in 68 (83%) patients. Hypovolemic shock was noted in 48 (58.6%) patients while 24 (29.3%) patients had hemoglobin level less than 10g/dl. High level of blood urea was noted in 23 (28%) patients, 1(1.2%) patient proved to have malignant tumor and 5(6.1%) patients had past medical history of diabetes mellitus. Fifty two (63.4%) patients had multiple risk factors. Double layer anastomosis was applied in 58 (70.7%) cases and single layer interrupted technique was done in 24 (29.3%) patients. Five (6.1%) patients developed anastomosis leak. Leak rate in single layer anastomosis was 4.2% and 6.9% in double layer anastomosis.
Conclusions: Peritonitis, hypovolemia and low hemoglobin alone or in combination are associated with increased risk of small bowel anastomotic leakage especially after emergency surgery. Single layer extra mucosal interrupted anastomosis was associated with less risk of dehiscence than double layer anastomosis.
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