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. 2024 Jul;26(7):1437-1446.
doi: 10.1111/codi.17076. Epub 2024 Jun 17.

Stenosis of the colorectal anastomosis after surgery for diverticulitis: A national retrospective cohort study

Jean-Francois Hamel  1   2 , Arnaud Alves  3 , Laura Beyer-Bergot  4 , Philippe Zerbib  5 , Valérie Bridoux  6 , Gilles Manceau  7 , Yves Panis  8 , Etienne Buscail  9 , Iman Khaoudy  10 , Martin Gaillard  11 , Manon Viennet  12 , Alexandre Thobie  13 , Benjamin Menahem  3 , Clarisse Eveno  14 , Catherine Bonnel  15 , Jean-Yves Mabrut  16 , Bodgan Badic  17 , Camille Godet  18 , Yassine Eid  19 , Emilie Duchalais  20 , Zaher Lakkis  21 , Eddy Cotte  22 , Anais Laforest  23 , Véronique Defourneaux  24 , Léon Maggiorri  25 , Lionel Rebibo  26 , Niki Christou  27 , Ali Talal  28 , Diane Mege  29 , Mathilde Aubert  29 , Cécile Bonnamy  30 , Adeline Germain  31 , François Mauvais  32 , Christophe Tresallet  33 , Jean Roudie  34 , Alexis Laurent  35 , Bertrand Trilling  36 , Martin Bertrand  37 , Damien Massalou  38 , Benoit Romain  39 , Hadrien Tranchart  40 , Mehdi Ouaissi  41 , Alexandra Pellegrin  42 , Charles Sabbagh  42 , Aurélien Venara  1   43   44 ; French Surgical Association
Affiliations

Stenosis of the colorectal anastomosis after surgery for diverticulitis: A national retrospective cohort study

Jean-Francois Hamel et al. Colorectal Dis. 2024 Jul.

Abstract

Aim: The aim of this work was to investigate the association between early postoperative anastomotic leakage or pelvic abscess (AL/PA) and symptomatic anastomotic stenosis (SAS) in patients after surgery for left colonic diverticulitis.

Method: This is a retrospective study based on a national cohort of diverticulitis surgery patients carried out by the Association Française de Chirurgie. The assessment was performed using path analyses. The database included 7053 patients operated on for colonic diverticulitis, with surgery performed electively or in an emergency, by open access or laparoscopically. Patients were excluded from the study analysis where there was (i) right-sided diverticulitis (the initial database included all consecutive patients operated on for colonic diverticulitis), (ii) no anastomosis was performed during the first procedure or (iii) missing information about stenosis, postoperative abscess or anastomotic leakage.

Results: Of the 4441 patients who were included in the final analysis, AL/PA occurred in 327 (4.6%) and SAS occurred in 82 (1.8%). AL/PA was a significant independent factor associated with a risk for occurrence of SAS (OR = 3.41, 95% CI = 1.75-6.66), as was the case for diverting stoma for ≥100 days (OR = 2.77, 95% CI = 1.32-5.82), while central vessel ligation proximal to the inferior mesenteric artery was associated with a reduced risk (OR = 0.41; 95% CI = 0.19-0.88). Diverting stoma created for <100 days or ≥100 days was also a factor associated with a risk for AL/PA (OR = 3.08, 95% CI = 2-4.75 and OR = 12.95, 95% CI = 9.11-18.50). Interestingly, no significant association between radiological drainage or surgical management of AL/PA and SAS could be highlighted.

Conclusion: AL/PA was an independent factor associated with the risk for SAS. The treatment of AL/PA was not associated with the occurrence of anastomotic stenosis. Diverting stoma was associated with an increased risk of both AL/PA and SAS, especially if it was left for ≥100 days. Physicians must be aware of this information in order to decide on the best course of action when creating a stoma during elective or emergency surgery.

Keywords: anastomotic leakage; anastomotic stenosis; diverticulitis; pelvic abscess; surgery.

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References

REFERENCES

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