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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2003 October-December;16(5-6):167-72
Postoperative peritonitis due to anastomosis dehiscence after colonic resection. Retrospective analysis of risk factors and review of the literature
Giglio D., Formisano V., Marano A., De Angelis C.P., Aveta M., Famiani M.,DI Muria A.
Aim. Intraperitoneal sepsis due to anastomotic leakage significantly affects the outcomes of intestinal surgery. The aim of this retrospective review is to examine retrospectively general and local factors involved and their prognostic value.
Methods. Between April 1993 and April 2003, 367 patients underwent elective (217=59%) or emergency (150=41%) primary colonic resection for benignant (77=21%) or malignant (290=79%) disease.As a whole the following resections were performed: 124 right colon resections with immediate anastomoses (primary resection), 65 (52.4%) emergency and 59 (47.6%) elective; 171 left colon primary resections, 73 (42.7%) emergency and 98 (57.3%) elective; 72 rectal primary resections, 12 (16.7%) emergency and 60 (83.3%) elective. We considered stapled or manual anastomoses, protective stomas and medical comorbidities.
Results. Perioperative mortality rate was 6.6% for emergency and 3.6% for elective procedures. The leak rate was 8.7% (32/367), 13.3% for emergency and 5.5% for elective procedures. Fistula affected 7/124 (5.6%) ileo-colic, 13/171 (7.6%) colo-colic and 12/72 (16.6%) colo-rectal anastomoses. Twenty-one dehiscences were treated conservatively (3 of these were reoperated), while 11, severe and all located in left colon, underwent a Hartmann's procedure, with a perioperative mortality rate of 35.7%.
Conclusion. In personal experience the site of colonic anastomoses represents the risk factor more strictly related to anastomotic leak rate, while other technical factors seem weakly associated to leakage; medical comorbidities are found in anastomotic fistulas in a significantly high percentage of cases (65.6%).