Anastomotic leak rate and outcome for laparoscopic intra-corporeal stapled anastomosis

Abstract

Aims: A prospective clinical audit of all patients undergoing laparoscopic surgery with the intention of primary colonic left-sided intracorporeal stapled anastomosis to identify the rate of anastomotic leaks on an intention to treat basis with or without defunctioning stoma.

Materials and methods: All patients undergoing laparoscopic colorectal surgery resulting in left-sided stapled anastomosis were included with no selection criteria applied. All operations were conducted by the same surgical team and the same preparation and intraoperative methods were used. The factors analyzed for this audit were patient demographics (age and sex), indication for operation, procedure performed, height of anastomosis, leak rate and the outcome, inpatient stay, mortality, rate of defunctioning stomas, and rate of conversion to open procedure. Results for anastomotic leakage were compared with known results from the Wessex Colorectal Audit for open colorectal surgery.

Results: A total of 69 patients (43 females, 26 males; median age 69 years, range 19 - 86 years) underwent colonic procedures with left-sided intracorporeal stapled anastomoses. Of these, 14 patients underwent reversal of Hartmann's, 42 - Anterior Resection, 11 - Sigmoid Colectomy, 2 - Left Hemicolectomy. Excluding reversals of Hartmann's, 29 operations were performed for malignant and 26 for benign disease. Five patients were defunctioned, and 3 were subsequently reversed. The median height of anastomosis was 12 cm, range 4 - 18 cm from anal verge as measured either intra-operatively, or by rigid sigmoidoscopy post-operatively. Four cases were converted to open surgery. There was 1 post-operative death within 30 days. There was 1 anastomotic leak (the patient that died), and 1 patient developed a colo-vesical fistula. Median post-operative stay was 7 days, range 2-19.

Conclusion: This clinical audit confirms that the anastomotic leak rate for left-sided colorectal stapled anastomosis is no worse than that for open surgery. Therefore the decision making process for defunctioning stoma should be guided by the same principles as open surgery.

Keywords: Anastomotic leak; laparoscopic intra-corporeal anastomosis.

Figure 1

Defunctioning in relation to the level of anastomosis

Figure 2

Rate of conversion in relation to the height of anastomosis

Figure 3

The graph illustrates the general trend (represented by the red line) of post-operative stay becoming shorter as the experience accumulated with increasing number of cases.