Anastomotic leakage after anterior resection of the rectum.

OBJECTIVE

To evaluate the results of elective colorectal operations, to identify factors that influence the anastomotic leak rate, and to assess the value of a covering colostomy.

DESIGN

Retrospective study.

SETTING

University hospital.

SUBJECT

134 consecutive patients undergoing elective resection for a neoplasm (125 carcinomas and 10 villous adenomas) of the colon and rectum.

INTERVENTIONS

135 operations (one for a recurrence in the anastomotic line).

MAIN OUTCOME MEASURES

Morbidity and mortality.

RESULTS

Two patients died (1%) and there were 29 complications (21%); 16 patients developed clinical anastomotic leaks (12%) and 3 patients symptomatic strictures (2%). One patient who developed a leak died and 11 of the 16 (69%) were re-operated on. The rest settled spontaneously. The only significant risk factor associated with leakage was distance of the anastomosis from the anal verge (all 16 leaks were within 7 cm, compared with 44/118 without leaks, p < 0.001). Four patients who developed leaks were left with permanent colostomies. Protecting stomas had no significant influence, despite the fact that only 1 of those that developed leaks had a colostomy compared with 9/109 that did not.

CONCLUSION

Prospective controlled studies are needed to establish the true value of a covering colostomy after low colorectal anastomosis.