Anastomotic leakage: experience from a colorectal unit

Background: Whilst the incidence of anastomotic dehiscence is decreasing, it remains a significant setback to the patients and their surgeons. In most centres, minor leaks are treated conservatively but surgery remains an options. Major leaks are best treated aggressively by surgical means, as the mortality among this group of patients remains unacceptably high.
Methods: We reviewed all case-notes, radiological records and histology reports of all patients who underwent major colonic restorative resection between July 1997 and September 199 in order to determine the leak rate and their outcomes. Seven Surgeons (3 Consultant Colorectal surgeons and 4 Senior Colorectal Registrars) were involved in these resections.
Results: Of the 348 restorative resections performed during the study period, 6% leaked. In 52%, the leak was classified as major and all of these patients underwent further surgery. Most leaks followed anterior resection and in most patients the anastomoses were below the peritoneal reflection. Among the minor leaks, four of the patients were defunctioned primarily. Mortality rate among patients with major leaks remain significantly high.
Conclusion: Anastomotic dehiscence remains a significant problem. Although blood supply, nutritional factors, the level of anastomosis and the experience of the surgeon are perhaps the two most important factors that determine the outcome of anastomosis