Schrock et al identified a number of risk factors associated with leakage of a colonic anastomosis. Addressing any risk factors that are present can help reduce postoperative morbidity and mortality. The authors are from the University of California in San Francisco.


Factors associated with leakage of a colonic anastomosis:

(1) preoperative anemia

(2) intraoperative hypotension

(3) massive hemorrhage (associated with intraoperative hypotension)

(4) peri-operative transfusions (especially if 4 or more units transfused)

(5) emergency surgery without adequate bowel preparation, especially in the left colon (associated with infection)

(6) presence of infection (before or after surgery)

(7) bowel within field for radiation therapy

(8) surgical margins positive for malignancy

(9) prolonged duration of surgery (> 5 hours)

(10) poor blood supply

(11) increased age (noticeable if > 60 and more so if > 81 years of age)

(12) extraperitoneal rectal anastomosis


Interestingly, steroid therapy, malnutrition and comorbid diseases were not associated with increased risk of leakage.


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