engleski

Anastomotic leak after laparoscopic vs. open bowel resections

Clinical anastomotic leak was identified in 9 patients (5 male, 4 female) with median age of 59 years (range 37-83 years). The overall clinical anastomotic leak rate for all large bowel resections was 5%. One patients died so the mortality rate associated with anastomotic leak was 11, 1 %. In our patients clinical anastomotic leak only occurred after low anterior resections. Overall 61 low rectal resections was performed (27 laparoscopic and 34 by open approach). Clinical anastomotic leak was detected in 6 patients after low colorectal and in 3 after coloanal anastomosis. So the rate of clinical anastomotic leak was 14, 75 % after low anterior resections (lap 14, 81%, open 14, 70%). There was no difference in overall clinical anastomotic leak between laparoscopic (5 of 92/5, 43 %) and open procedures (4 of 88/ 4, 54%). An increased risk of anastomotic dehiscence was: rectal location of the disease, ASA score ≥3, and prolonged (>3h) operative time. The median time to diagnosis of anastomotic leak following surgery was 4 days (range 2-9). Eight patients with clinical anastomotic leak were re-operated. Two had the anastomosis taken down with end colostomy (Hartmann procedure) and 6 patients had the anastomosis defunctioned by loop ileostomy without taking down primary anastomosis. One patient was successfully treated with transanal placement of an endo-sponge. Hospital stay for patients with anastomotic leak was significantly longer (range 8-71 days). CONCLUSION: Overall clinical anastomotic leak after colorectal resections was 5 %. The risk for clinical anastomotic leak was higher as the anastomoses were constructed more distally, and occurred only after low colorectal or coloanal anastomotis. In our modest study we did not noticed difference in clinical anastomotic leak between laparoscopic and open type of surgery

anastomotic leak; bowel resection

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