Anastomotic leakage after anterior resection of the rectum

Abstract

Objective: To evaluate the results of elective colorectal operations, to identify factors that influence the anastomotic leak rate, and to assess the value of a covering colostomy.

Design: Retrospective study.

Setting: University hospital.

Subject: 134 consecutive patients undergoing elective resection for a neoplasm (125 carcinomas and 10 villous adenomas) of the colon and rectum.

Interventions: 135 operations (one for a recurrence in the anastomotic line).

Main outcome measures: Morbidity and mortality.

Results: Two patients died (1%) and there were 29 complications (21%); 16 patients developed clinical anastomotic leaks (12%) and 3 patients symptomatic strictures (2%). One patient who developed a leak died and 11 of the 16 (69%) were re-operated on. The rest settled spontaneously. The only significant risk factor associated with leakage was distance of the anastomosis from the anal verge (all 16 leaks were within 7 cm, compared with 44/118 without leaks, p < 0.001). Four patients who developed leaks were left with permanent colostomies. Protecting stomas had no significant influence, despite the fact that only 1 of those that developed leaks had a colostomy compared with 9/109 that did not.

Conclusion: Prospective controlled studies are needed to establish the true value of a covering colostomy after low colorectal anastomosis.