Publication:

Factors affecting the outcome of intestinal anastomosis: a prospective study

Background Anastomotic leak is one of the most dreaded complications after intestinal anastomosis. The prevalence of anastomotic leak is 0.5%-30% in literature and resulting mortality rate is 10%-15%. Various risk factors are known to be associated with it. This study was undertaken with the aim to identify and evaluate these predisposing factors.

Methods A prospective study was conducted from March 2019 to February 2020 at Teerthankar Mahaveer medical college and research centre, Moradabad. All patients undergoing hand-sewn gastro-intestinal anastomosis electively as well as in emergency were included in this study. The total number of cases studied were 80.

Results Post-operative anastomotic leaks were present in 10% and associated mortality was 100%. Increasing age was associated with leakage (p=0.02) and 75% patients with leaks were male. The following were observed to be significant risk factors associated with anastomotic dehiscence: diabetes mellitus (p=0.05), pallor (p=0.01), low haemoglobin (p=0.003), altered TLC count (p=0.008) low serum protein (p=0.001), albumin (p=0.001) longer operative time (p=0.02). Other predisposing factors like serum creatinine, hyperbilirubinema, elective/emergency surgeries, contamination of peritoneal cavity and time taken to perform the anastomosis were insignificant statistically.

Conclusions This study identified and assessed the various risk factors associated with anastomotic leaks and found age, sex, anaemia, sepsis, hypoproteinemia, hypoalbuminemia, increased operative-time to be significant and we concluded that controlling these factors will help in minimizing the chances of anastomotic dehiscence.