Predictive Factors for Small Intestinal and Colonic Anastomotic
Leak: a Multivariate Analysis
Sameh Hany Emile
Received: 26 May 2016 /Accepted: 7 October 2016 /Published online: 17 October 2016
Association of Surgeons of India 2016
Abstract Anastomotic leak (AL) is a serious complication of
intestinal surgery with various predisposing factors. This
study aims to assess several risk factors associated with AL
after small intestinal and colonic anastomoses through a mul-
tivariate analysis. Two hundred twenty-four patients (126
males) with intestinal anastomosis of a median age of 44 years
were reviewed. Independent factors associated with AL were
male gender (OR = 2.59, P = 0.02), chronic liver disease
(CLD)(OR=8.03,P < 0.0001), more than one associated
comorbidity (OR = 5.34, P = 0.017), anastomosis conducted
as emergency (OR = 2.73, P = 0.012), colonic anastomosis
(OR = 2.51, P = 0.017), preoperative leukocytosis (OR = 2.57,
P = 0.015), and intraoperative blood transfusion (OR = 2.25,
P = 0.037). Predicative factors significantly associated with
AL were male gender, CLD, multiple comorbidities, emergent
anastomoses, colonic anastomoses, preoperative leukocytosis,
and intraoperative blood transfusion.
Keywords Anastomotic leak
Anastomotic leak (AL) is a serious complication of surgery of
the alimentary tract in general, and of intestinal surgery in
particular. The gravity of anastomotic disruption extends be-
yond being an isolated complication to include further life-
threatening complications and sometimes mortality.
Leak after intestinal anastomosis varies from 0.5 to 30 %,
[1–3], and it can reach up to 39 % according to Buchs and
colleagues . Overall incidence of colorectal AL ranges from
1.5 to 16 % globally .
Various risk factors are associated with AL which can be
subdivided into systemic and local factors; both entities con-
tribute to poor healing and failure of anastomosis .
Systemic conditions include anemia, diabetes mellitus (DM),
malnutrition, hypoalbuminemia, and prolonged steroid thera-
py. Local factors comprise local irradiation of bowel, diseased
bowel as in Crohn’s disease, and intestinal ischemia. In addi-
tion, high ligation of inferior mesenteric artery is considered a
unique risk factor for disruption of colonic anastomosis .
AL varies with regard to the onset of its occurrence. Early
leak occurs on the first or second postoperative days, mostly
due to technical reasons. Latent leak, which is attributed to
failure of the normal healing mechanism, occurs around the
end of the first postoperative week.
Clinically, AL has different presentations, when the leak is
controlled, it presents as localized intraperitoneal abscess,
whereas in cases of uncontrolled leak, frank peritonitis super-
venes . Some leaks present in a subtle fashion, often late in
the postoperative period .
* Ahmad Sakr
Sameh Hany Emile
Department General surgery, Faculty of Medicine, Mansoura
University Hospitals, Elgomhuoria Street, Mansoura city, Dakahlia,
Indian J Surg (December 2017) 79(6):555–562