Risk Factors for Anastomotic Leakage Following Stoma Closure: A Retrospective Study in Tertiary Hospitals in Yemen

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.