A Prospective Study to Understand the Risk Factors for Anastomotic Leak in Small Bowel Anastomosis

ABSTRACT

Small intestinal anastomosis is a common GI procedure. Anastomotic leaks increase morbidity, mortality and hospital stay in patients undergoing bowel anastomosis. Understanding the risk factors associated with anastomotic leak not only helps to reduce the incidence of leaks but also to identify the patients who are candidates for creation of stomas. The aim of the study is to define the risk factors associated with anastomotic leak following small bowel anastomosis.METHODSA total of 74 patients who underwent small bowel anastomosis in our study period between September 2016 and December 2019 in Karuna Medical College, Palakkad, were prospectively followed up and divided into two groups, leak and non-leak group depending on occurrence of anastomotic leak. Many host and disease related factors known to influence the outcome of anastomosis were recorded in both groups and compared.RESULTSOut of 74 patients, 40 were males and 34 females. 10 patients were aged more than 60 years. 26 of them had perforation and peritoneal contamination. Out of 74, 67 were emergency surgeries and 7 were elective surgeries. 14 patients were anaemic, 19 were hyponatraemic and 12 were hypoalbunemic. In total, 13 patients developed anastomotic leak. Overall mortality and morbidity was 6.7% (5 patients) and morbidity was 40.5% (30 patients). Mortality in anastomotic leak group was 23% (3 patients).CONCLUSIONSHypoalbuminemia (P value- 0.016) and presence of peritoneal contamination (P value= 0.004) were found to significantly increase the risk of anastomotic leak in the present study. In the presence these risk factors, it is better to consider the patient for diverting stoma in emergency setting and consider improving patient nutritional status in elective setting.