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A Prospective Study of 259 Left-Sided Colorectal Anastomoses

Juliette C. Slieker, MD; Niels A. P. Komen, MD; Guido H. Mannaerts, MD, PhD; Tom M. Karsten, MD, PhD; Paul Willemsen, MD; Magdalena Murawska, MS; Johannes Jeekel, MD, PhD; Johan F. Lange, MD, PhD

Arch Surg. Published online January 16, 2012. doi:10.1001/archsurg.2011.1690

Objective  To determine the risk factors for symptomatic anastomotic leakage (AL) after colorectal resection.

Design  Review of records of patients who participated in the Analysis of Predictive Parameters for Evident Anastomotic Leakage study.

Setting  Eight health centers.

Patients  Two hundred fifty-nine patients who underwent left-sided colorectal anastomoses.

Intervention  Corticosteroids taken as long-term medication for underlying disease or perioperatively for the prevention of postoperative pulmonary complications.

Main Outcome Measures  Prospective evaluations for risk factors for symptomatic AL.

Results  In 23% of patients, a defunctioning stoma was constructed. The incidence of AL was 7.3%. The clinical course of patients with AL showed that in 21% of leaks, the drain indicated leakage; in the remaining patients, computed tomography or laparotomy resulted equally often in the detection of AL. In 50% of patients with AL, a Hartmann operation was needed. The incidence of AL was significantly higher in patients with pulmonary comorbidity (22.6% leakage), patients taking corticosteroids as long-term medication (50% leakage), and patients taking corticosteroids perioperatively (19% leakage). Perioperative corticosteroids were prescribed in 8% of patients for the prevention of postoperative pulmonary complications.

Conclusions  We found a significantly increased incidence of AL in patients treated with long-term corticosteroids and perioperative corticosteroids for pulmonary comorbidity. Therefore, we recommend that in this patient category, anastomoses should be protected by a diverting stoma or a Hartmann procedure should be considered to avoid AL.

Trial Registration  trialregister.nl Identifier: NTR1258

Author Affiliations: Departments of Surgery (Drs Slieker, Komen, Jeekel, and Lange) and Biostatistics (Ms Murawska), Erasmus University Medical Centre, and Department of Surgery, St. Franciscus Gasthuis (Dr Mannaerts), Rotterdam, and Department of Surgery, Reinier de Graaf Groep, Delft (Dr Karsten), the Netherlands; and Department of Surgery, ZNA Middelheim, Antwerp, Belgium (Drs Komen and Willemsen).

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