Publication:

A study of factors leading to postoperative leaks following bowel anastomosis with special reference to hypoalbuminemia

Background Bowel anastomosis is a critical surgical procedure performed during gastrointestinal resections, with outcomes influenced by various preoperative, intraoperative, and postoperative factors. This study aims to evaluate the clinical and surgical parameters affecting complications, morbidity, and mortality in patients undergoing bowel resection and anastomosis.

Methods A prospective observational study was conducted on 50 patients undergoing small or large bowel resection with anastomosis. Data were collected on demographics, comorbidities, serum albumin and hemoglobin levels, type of surgery (elective/emergency), technique of anastomosis (hand-sewn/stapled), and intraoperative contamination. Postoperative complications such as wound infection, anastomotic leak, pelvic collection, and mortality were recorded and statistically analyzed.

Results The majority of patients were male (66%) and underwent small bowel surgeries (70%). Hand-sewn anastomosis was performed in 66% of cases. Elective procedures accounted for 58% and emergency for 42%. Intraoperative contamination was present in 46% of patients. Postoperative complications occurred in 46%, with surgical site infection (28%) being the most common, followed by ileus (12%) and pelvic collection (6%). Anastomotic leaks occurred in 10%, and the overall mortality was 10%. Emergency surgeries and intraoperative contamination showed a statistically significant association with mortality (p=0.022 and p=0.037, respectively). Hypoalbuminemia (≤3.5 g/dl) was associated with a higher rate of anastomotic leaks (17.4%) and mortality (17.4%), though the latter was not statistically significant (p=0.089).

Conclusions Emergency surgery, hypoalbuminemia, and intraoperative contamination are significant risk factors for postoperative complications and mortality following bowel anastomosis. Early diagnosis, nutritional optimization, aseptic techniques, and elective intervention when feasible may improve surgical outcomes.