Al-Shehari Mohammed, Obadiel Yasser A, Abdulwahab Matheel M, Jowah Haitham M
Department of Surgery, Faculty of Medicine and Health Science, Sana'a University, Sana'a, YEM.
Department of Surgery, Al-Thawra Modern General Hospital, Sana'a, YEM.
Cureus. 2024 Dec 9;16(12):e75407. doi: 10.7759/cureus.75407. eCollection 2024 Dec.
Introduction Anastomotic leakage (AL) following stoma closure is a significant complication that can lead to increased morbidity and mortality. Identifying risk factors associated with AL is essential for improving surgical outcomes, especially in resource-limited settings like Yemen. Methods We conducted this retrospective study at Al-Thawra Modern General Hospital and the Republican Teaching Hospital Authority in Sana'a, Yemen, between August 2020 and April 2024. The analysis included 50 patients aged 18-65 years who underwent stoma closure. We analyzed patient data, including demographics, comorbidities, surgical technique, and outcomes, to identify risk factors for AL. Results The incidence of AL was six (12%) out of 50 cases. Significant risk factors included smoking, with AL present in four (67%) smokers and two (33%) non-smokers (p = 0.045). Patients with diverticulitis were more likely to require a stoma in two (33%) cases, and perforated small bowel with peritonitis in one (17%) case, compared to trauma cases in two (7%) and colorectal cancer cases at one (11%) (p = 0.038). AL was most common in colorectal anastomosis, observed in four (67%) cases, compared to other sites in two (5%) cases (p = 0.001). The surgical technique impacted the incidence of AL, with hand-sewn anastomosis showing a higher rate in four (67%) cases compared to stapled anastomosis in two (33%) cases (p = 0.036). No significant associations were found for age, sex, American Society of Anesthesiologists (ASA) classification, or surgeon experience. Conclusion This study identifies key risk factors for AL following stoma closure in the context of hospitals in Yemen, emphasizing the need for targeted preoperative and intraoperative strategies, such as smoking cessation and careful surgical technique selection, to reduce the risk of AL. Future studies should focus on larger cohorts and the impact of enhanced perioperative care protocols in low-resource settings.
造口关闭术后吻合口漏（AL）是一种严重的并发症，可导致发病率和死亡率增加。识别与AL相关的风险因素对于改善手术结果至关重要，尤其是在也门这样资源有限的地区。方法：我们于2020年8月至2024年4月在也门萨那的Al-Thawra现代综合医院和共和国教学医院管理局进行了这项回顾性研究。分析纳入了50例年龄在18至65岁之间接受造口关闭术的患者。我们分析了患者数据，包括人口统计学、合并症、手术技术和结果，以确定AL的风险因素。结果：50例病例中，AL的发生率为6例（12%）。显著的风险因素包括吸烟，4例（67%）吸烟者发生AL，2例（33%）非吸烟者发生AL（p = 0.045）。与2例（7%）创伤病例和1例（11%）结直肠癌病例相比，憩室炎患者中有2例（33%）更有可能需要造口，1例（17%）小肠穿孔伴腹膜炎患者需要造口（p = 0.038）。AL在结直肠吻合术中最为常见，有4例（67%），而其他部位有2例（5%）（p = 0.001）。手术技术影响AL的发生率，手工缝合吻合术有4例（67%）发生率较高，而吻合器吻合术有2例（33%）（p = 0.036）。未发现年龄、性别、美国麻醉医师协会（ASA）分级或外科医生经验有显著关联。结论：本研究确定了也门医院环境下造口关闭术后AL的关键风险因素，强调需要有针对性的术前和术中策略，如戒烟和谨慎选择手术技术，以降低AL的风险。未来的研究应关注更大的队列以及在资源有限环境中加强围手术期护理方案的影响。
