Minerva chirurgica · 2003
[Anastomotic leakage after traditional surgery of the colon and rectum].
Аннотация на английскомСтатьяОбзорНазвание и аннотация: Перевод в очереди
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Abete M, Ronchetti V, Casano A, Pescio G
Аннотация
BACKGROUND: 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.
METHODS: 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).
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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).
RESULTS: 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.
CONCLUSIONS: 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.