Clinical Factors Influencing Bowel Anastomotic Leak

Abstract

Background and objectives: Anastomotic leakage is one of the most feared complications of gastrointestinal surgery. It causes considerable morbidity and mortality to the patient as well as trying the patience of the surgical team: it doubles the length of the hospital stay and increases the mortality as much as 8 to 10 fold. The objectives of this study were: 1. To study the demographic profile of patients who have anastomotic leak postoperatively. 2. To determine whether the risk factors of: hypoalbuminaemia; preoperative anaemia; emergent setting of surgery; intraoperative hypotension; body mass index; duration of surgery; post operative blood transfusions and dyselectrolytaemia contribute significantly to anastomotic leaks after resection anastomosis of bowel. Methodology: This study was conducted on 87 patients who underwent resection-anastomosis in Victoria Hospital, either in Emergency or Elective OT between 1^st December 2013 and 31^st May 2015. Cases with comorbidities of uncontrolled DM, HIV/AIDS and carcinoma were excluded in this study. Results : Serum albumin (p-value-0.01), BMI (0.05), serum potassium (0.05) and need for post operative blood transfusion (0.04) were strongly associated with bowel AL. Conclusion : In the presence of: Serum albumin pre-operative value of 3.2g/dl or lower; Serum potassium pre-operative value of 3.8 mmol/L or lower, and Need for post-operative blood transfusion, it is important that the operating surgeon make a decision to prevent AL by either creating a diversionary stoma proximal to the site of anastomosis (for emergency patients) or pre-optimize the patient with nutritional support (for elective patients).