Effective initial management of anastomotic leak in the maintenance of functional colorectal or coloanal anastomosis - Inria - Institut national de recherche en sciences et technologies du numérique Access content directly
Journal Articles Surgery Today Year : 2022

Effective initial management of anastomotic leak in the maintenance of functional colorectal or coloanal anastomosis

Abstract

Purpose The present study assessed the factors associated with the maintenance of a functional anastomosis in a large consecutive series of patients with anastomotic leakage (AL). Methods All consecutive patients presenting with AL after colorectal or coloanal anastomosis (2012–2019) were analyzed. The primary end point was a functional anastomosis without a stoma at 1 year. Results A total of 156 patients were included. AL was initially treated by antibiotics (38%), drainage (43%) or urgent surgery (19%). Initial treatment of AL was not adequate in 24.3%, and reintervention in the form of drainage or surgery was required. A total of 60.9% of patients had a functional anastomosis without a stoma 1 year after surgery. Factors associated with the risk of anastomotic failure at 1 year were diabetes (odds ratio [OR] = 4.24 [95% confidence interval {CI} 1.39–14.24] p = 0.014), neoadjuvant chemoradiotherapy (OR = 3.03 [95% CI 1.14–8.63] p = 0.03) and Grade B (OR = 6.49 [95% CI 2.23–21.74] p = 0.001) or C leak (OR = 35.35 [95% CI 9.36–168.21] p < 0.001). Among patients treated initially by drainage, side-to-end or J-pouch anastomoses were significantly associated with revision of the anastomosis compared to end-to-end (OR = 12.90, p = 0.04). Conclusion After acute AL following coloanal or colorectal anastomosis, 60.9% of patients had a functional anastomosis without a stoma at the 1 year of follow-up. The type of treatment of AL influenced the risk of anastomotic failure.

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Surgery
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Dates and versions

hal-03864962 , version 1 (22-11-2022)

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Alexandra Nassar, Alexandre Challine, Lauren O’connell, Thibault Voron, Najim Chafaï, et al.. Effective initial management of anastomotic leak in the maintenance of functional colorectal or coloanal anastomosis. Surgery Today, 2022, ⟨10.1007/s00595-022-02603-7⟩. ⟨hal-03864962⟩
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