Suitability of Primary Anastomosis for Colorectal Perforation

Abstract

Colorectal perforation is often treated with colostomy without primary anastomosis due to the risk of anastomotic leakage. However, colostomy affects the patients’ quality of life and may cause complications during closure. This study aimed to examine the suitability of primary anastomosis for colorectal perforation and determine the risk factors for postoperative anastomotic leakage. We retrospectively examined patients who underwent emergency surgery for colorectal perforation associated with generalized peritonitis between April 2007 and March 2017. Cases with iatrogenic or traumatic causes were excluded. Patients were divided into primary anastomosis and colostomy groups. Their age, time after onset, preoperative sequential organ failure assessment (SOFA) score, perforation site, cause of perforation, shock, intraperitoneal infection, steroid use, chronic renal failure, and mortality were compared. Subgroup analysis of the primary anastomosis group was performed to identify risk factors for anastomotic leakage. The cohort comprised 232 patients (112 men, 120 women; mean age, 73 years). Primary anastomosis and colostomy were performed in 27 and 205 patients, respectively. The primary anastomosis group consisted mainly of men with right colonic perforation. Of the 27 patients who underwent primary anastomosis, anastomotic leakage occurred in 5 (18.5%). Patients with anastomotic leakage demonstrated high SOFA scores (4.2 vs. 1.9, p < 0.05) and Hinchey stage IV disease (80% vs. 27.3%, p < 0.05). Of the 5 patients with anastomotic leakage, 2 died. Anastomotic leakage after primary anastomosis for colorectal perforation occurs in patients with septic complications or severe intraperitoneal infection. Therefore, primary anastomosis should be avoided in this patient population.