Anastomotic Leaks after Gastrointestinal Operations- A Prospective Cohort Study PC01-PC04
Pitrichhaya, C/O Dr. Arjun Sharma, Arpana Bank Colony, Ramjaipal Road, Baily Road, Near Hi Tech Apartment, Patna, Bihar, India.
Introduction: Anastomotic leak is the release of intestinal contents into the abdomen at the site of surgical stitch line, where two ends of the bowel have been joined for restoration of the gastrointestinal continuity. There are considerable variations in incidence of anastomotic leaks following gastrointestinal operations which have motivated the present study.
Aim: The objective of the present study was to prospectively follow all the patients who underwent gastrointestinal surgeries and look for clinical signs of anastomotic leak in postoperative period.
Materials and Methods: Study population comprised of 613 patients who underwent gastrointestinal operation at a tertiary care hospital during the period from September 2011 to September 2013. After taking institutional ethical committee clearance enrolment in the study was done with written and informed consent. The site of leak, postoperative day of leak was diagnosed and noted based on clinical examination and radiological investigations.
It was a prospectively designed descriptive study so no specific tests were applied. Statistical analysis and percentages were calculated using SPSS 16.0 software.
Results: Most of the leaks occurred between eighth to ninth postoperative day and most of the obstruction occurred on sixth and seventh postoperative day. Incidence of anastomotic leaks in the study group was 3.26%. Incidence of anastomotic leaks in small bowel anastomosis is 6.25% compared to large bowel leaks reported to be 9.8%. Peritonitis was present in majority of patients presenting with leak. Incidence of obstruction in recto sigmoid anastomosis was 9.92%.
Conclusion: The study suggests that as we move distally in Gastrointestinal Tract (GI) the incidence of anastomotic leak increases and it becomes maximum for colorectal surgeries. Anastomotic complication depends on various factors like age, sex, mode of presentation, procedure done, Hb%, dehydration, nutrition, blood sugar, albumin, peritonitis etc.