Anastomotic Leak after Colorectal Surgery: Leak Rate For Right Hemicolectomy may be Higher than Expected

Abstract

Background: Despite of the increasing knowledge and developing technology anastomotic leak (AL) is still a serious complication of colorectal surgery. The aim of this study was to evaluate the management and outcomes of AL after colorectal surgery. Methods: The study included all patients diagnosed with AL after colorectal surgical procedures between January 2005 and December 2009. Patient demographics, diagnoses, AL management protocols, and outcomes were reviewed. Since the highest AL rate was detected for right hemicolectomy, two groups were identified based on the index surgery in order to determine the differences between the patients: right hemicolectomy and other procedures. Results: In total, 28 of 550 (5.1%) patients that underwent colorectal surgical procedures were diagnosed with AL. There were 24 males with a median age of 61 (35- 93) years. Right hemicolectomy was associated with the highest procedure-specific AL rate (10.44%). In the right hemicolectomy group, patients had higher ASA scores, underwent more frequent emergency procedures, and majority of them were operated by residents comparing to the other procedures group (p<0.05). Twenty-four patients required surgical intervention for AL, and 23 patients that underwent re-operation required a stoma; end colostomy was the most frequent procedure (50%). AL-specific morbidity rate was 57.1% whereas the mortality rate among the patients with AL was 25%. Conclusion: AL after colorectal surgery is associated with high morbidity and mortality. Patients with high ASA score, emergency procedure, and inexperienced surgeon may be factors requiring extra attention in terms of high AL risk after right hemicolectomy comparing to the other colorectal procedures.