ANASTOMOTIC LEAK AFTER SMALL GUT SURGERY

Abstract

Background: Anastomotic leak after gastrointestinal surgery is an
important postoperative event that leads to significant morbidity and mortality. Postoperative leak rates are frequently
used as an indicator of the quality of surgical care provided. Objective:(1).To define factors associated with leakage
of small gut anastomosis. (2) To find technique of small gut anastomosis associated with lowest risk of anastomotic
dehiscence. Study Design: Retrospective, Descriptive Duration: 02 Years (May 2003 to May 2005) Material and
Methods: This study was conducted at Surgical Unit-II, Allied Hospital, Punjab Medical College, Faisalabad from Dec
2003 to May 2005. A total number of 36 cases were included in this study comprising of both adult male and female
patients developing anastomotic dehiscence following resection and end to end anastomosis of small gut. Results:
Peritonitis was the risk factor identified in 69% of the patients. Hypovolemic shock both preoperatively and in the
immediate postoperative period was noted in 56% cases while 83% of the patients with anastomotic dehiscence had
haemoglobin concentration less than 10g%. High concentration of blood urea was noted in 42% of the cases. It turned
to normal as soon as the hypovolemia was corrected in these cases. Small gut anastomosis done in emergency setting
(75% cases) was associated with increased risk of anastomotic dehiscence as compared to the dehiscence noted in
09 cases (25%) operated on elective list. Three different techniques were used for small gut anastomosis. The rate of
anastomotic leakage ranged from 19-45%. Conclusion: Peritonitis, hypovolaemia and low hemoglobin alone or in
combination are associated with increased risk of small gut anastomotic leakage especially after emergency surgery.
Single layered extramucosal interrupted anastomosis was associated with less risk of dehiscence than the full thickness
and continuous extramucosal anastomosis.