Risk factors of low colorectal anastomosis leakage
Abstract Anastomotic leakage (AL) after low anterior resection (LAR) with total mesorectal excision (TME) is a life-threatening complication with the rate achieving 17%.
Aim. To determine risk factors of AL after LAR.
Material and methods. Between 2013 and 2015 one hundred patients had LAR with TME and de- functioning stoma for rectal neoplasia. The rate of AL and perioperative risk factors was assessed in univariant analysis and in the model of logistic regression. Patients with no clinical signs of AL had contrast enema examination aimed at detection of asymptomatic AL.
Results. AL rate was 20% (20/100). There were 11% (11/100) clinical AL and 9% (9/100) of roent-genological one. Following factors had negative influence on AL rate and reached statistical significance in univariant analysis: male gender (OR=4.74. 95%CI 1.57–14.35; р=0.005), tumor >4 cm (OR=9.94, 95% CI 2.16–45.73; р=0.0007), tumor stenosis (OR=6.93, 95%CI 2.34–20.26; р=0.0005), blood loss >200 ml (OR=3.15, 95%CI 1.05–9.50; р=0.045), intraoperative blood transfusion (OR=10.43, 95% CI 3.24–33.61; р=0.02). Transabdominal reinforcement of anastomosis decrease AL rate (OR=0.15, 95% CI 0.03–0.07; р=0.002). In logistic regression the only independent factor was intraoperative blood transfusion (р=0.050).
Conclusion. Intraoperative blood transfusion is independent risk factor of AL after LAR with defunctioning stoma.
Keywords:low anterior resection; colorectal anastomosis, anastomotic leakage
Clin. Experiment. Surg. Petrovsky J. 2016. № 2. Р. 80–88.
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