Patient selection: large bowel resection (colon or rectum), with 7% emergency operations
6% of patients in the series had an anastomotic leak, which was associated with 31% of deaths.
Risk factors for anastomotic leakage from multivariate analysis:
(1)
preoperative leukocytosis (white blood cell count > 10,000 per µL)
(2) intraoperative septic conditions (peritonitis)
(3) difficulties during the anastomosis
(4) colocolic anastomosis
(5) postoperative blood transfusion
An ileocolic anastomosis is performed for a right hemicolectomy, so colocolic anastomosis infers resection of transverse, descending or rectosigmoid colon.
The risk of anastomotic leak increases with the number of risk factors present.
|
Number of Risk Factors
|
Percent with Leak
|
|
1
|
12 to 30%
|
|
2
|
38%
|
|
3
|
50%
|
For a high risk patient the authors performed a temporary protective stoma. Other measures could be taken to reduce risk.
Only the first 4 would be known with certainty before or during surgery.
