[Anastomotic leakage after traditional surgery of the colon and rectum]

Anastomotic leakage after traditional surgery of the colon and rectum represents one of the more frightening complications for its high incidence (5-10%) leading to a mortality of 10-33%. The aim of the study is to analyze the main etiopathogenetic factors of this complication in the literature and, retrospectively, in personal experience.

At the General Surgery Department of the Hospital of Imperia, between September 1997 and August 2001, 278 laparotomic procedures with large bowel anastomosis were completed; 37 patients (13.3%) were treated in emergency. There were 153 males (55%) and 125 females (45%), the average age being 70.5 years (range 41-94). The mean hospital stay was 12 days (range 7-45).

The incidence of perioperative mortality was 1.1% (3 cases). Anastomotic leakage occurred in 4 patients (1.4%); one of these died. Analysis of the presented series confirms that factors contributing to leakage of colonic anastomoses are: distal rectum anastomoses, rectal cancer, experience of the surgeon and preoperative radiotherapy. Anastomotic leakage didn't occur in emergency, probably for a prudent attitude that considers multiple-stages surgical procedures in high-risk patients; besides a radical subtotal or total colectomy was performed in the treatment of obstructive cancer of the left colon and rectum.

The incidence of anastomotic leakage in colo-rectal surgery was lower when anastomoses were performed in ideal circumstances; it is necessary to know the main risk factors to reduce this complication.