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Year : 2019  |  Volume : 32  |  Issue : 2  |  Page : 574-580

Risk factors for leak in emergent small bowel anastomosis

1 Department of General Surgery, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
2 Department of General Surgery, Ministry of Health, El-Bagour, Menoufia Governorate, Egypt

Correspondence Address:
Ahmed SA Arafa
8 Mostafa Kamel Street, Kafr Fishaalkobra, Menouf 32511, Menoufia Governorate
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mmj.mmj_111_18

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Objective The objective of this study was to identify risk factors associated with intestinal anastomotic leakage (AL) to generate hypothesis for further investigation to practically assist in surgical decision making and reduction of postoperative morbidity and mortality. Background AL is a frequent complication of intestinal surgery and has been associated with postoperative morbidity and mortality. Patients and methods The study included 51 patients who presented to the Emergency Department at Menoufia University Hospital in the period between March and September 2017 requiring small bowel resection and reconstruction as an emergency procedure after illustrating the study to them and taking their consent to participate. Overall complication and leak rates were compared using Fisher's exact test. Individual case review by a group of peers was performed for patients with a leak who died to determine the relationship with mortality. Results A total of 51 emergency patients meeting the inclusion criteria underwent resection with anastomosis during the study period. There were 13/51 (25.4%) patients with leaks, four of whom died. In bivariate analysis, factors that were associated with AL were advancing age, hypoalbuminemia 12/13 (92.3%), intraoperative hypovolemia 8/13 (61.5%), intraoperative hypotension, diffuse peritonitis, and low hemoglobin concentration. Mortality was significantly increased in patients with AL, as four (4/51, 7.843%) cases died; three (3/13, 23.07%) of them had AL. Conclusion Multiple factors should be taken into consideration before and during emergency small bowel resection anastomosis surgery to comprehensively assess the risk for AL and reduce postoperative morbidity and mortality.

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