ANASTOMOTIC LEAK AFTER SMALL GUT SURGERY

Abstract

Background: Anastomotic leak after gastrointestinal surgery is animportant postoperative event that leads to significant morbidity and mortality. Postoperative leak rates are frequentlyused as an indicator of the quality of surgical care provided. Objective:(1).To define factors associated with leakageof small gut anastomosis. (2) To find technique of small gut anastomosis associated with lowest risk of anastomoticdehiscence. Study Design: Retrospective, Descriptive Duration: 02 Years (May 2003 to May 2005) Material andMethods: This study was conducted at Surgical Unit-II, Allied Hospital, Punjab Medical College, Faisalabad from Dec2003 to May 2005. A total number of 36 cases were included in this study comprising of both adult male and femalepatients developing anastomotic dehiscence following resection and end to end anastomosis of small gut. Results:Peritonitis was the risk factor identified in 69% of the patients. Hypovolemic shock both preoperatively and in theimmediate postoperative period was noted in 56% cases while 83% of the patients with anastomotic dehiscence hadhaemoglobin concentration less than 10g%. High concentration of blood urea was noted in 42% of the cases. It turnedto normal as soon as the hypovolemia was corrected in these cases. Small gut anastomosis done in emergency setting(75% cases) was associated with increased risk of anastomotic dehiscence as compared to the dehiscence noted in09 cases (25%) operated on elective list. Three different techniques were used for small gut anastomosis. The rate ofanastomotic leakage ranged from 19-45%. Conclusion: Peritonitis, hypovolaemia and low hemoglobin alone or incombination are associated with increased risk of small gut anastomotic leakage especially after emergency surgery.Single layered extramucosal interrupted anastomosis was associated with less risk of dehiscence than the full thicknessand continuous extramucosal anastomosis.