Predictive factors for anastomotic leakage in laparoscopic colorectal surgery

Background: Anastomotic leakage is one of the most feared complications of gastrointestinal surgery following any gastrointestinal anastomosis with overall impact on functional and oncologic outcome and drainage on hospital resources. It causes considerable morbidity and mortality. It is a serious complicationfollowing restorative resection for colorectal cancer (CRC) and contributes to local tumor recurrence. As the improvement in safety of oncologicalsurgeries has increased, the anastomotic leakage still remains the most feared and devastating complication in both the surgical and oncological views, respectively. Anastomotic leakage also affects the outcome of surgery, increases the hospitalization expenses and worsens the prognosis. Objectives: To identify pre- operative, intra-operative and post-operative predictive factors for anastomoticleak in patients undergoing colorectal resection by way of the laparoscopic approach. Study Design: It was a prospective-observational study of 18 months (one and a half year) conducted in the Department ofGeneral Surgery, GMC, Srinagar. Participants: A total of 35 cases of laparoscopic colorectal surgeries operated by a single well-experienced laparoscopic surgeon from a single surgical unit (>18 years of age) were included while patients ≤18 years and patients undergoing open colorectal procedures were excluded. Methodology: After admission detailed history and clinical examination of the patient was done. Patient's data including gender, age, clinical presentation, tumorlocation and histopathological type and grade of tumorwas noted. Pre-operative investigations concentrating on hematological and biochemical parameters, radiological imaging was done in each patient. Results: Out of 35 patients 2 (5.71%) patients had anastomotic leakage. In regard with the procedure done, anastomotic leakage occurred in 1 (5.6%) patient with right hemicolectomy and 1 (14.3%) patients with low anterior resection. Considering the type of anastomosis, both end-to-end and side-to-side anastomosis showed equal distribution in anastomotic leakage. Both the patients of anastomotic leakage had malignant disease. Conclusion: In our study, we had 2 patients out of 35 with anastomotic leakage. We observed higher age group, both male and female genders, type and site of anastomosis, level of anastomosis, size of tumor (≤2 cm above anal verge),intraoperative blood loss and underlying comorbidities such as vascular disease are the most prevalent risk factors for anastomoticleakage. Implications: Ours was an Observational Study. After observing the predictive factors for anastomotic leakage we recommend the thorough work-up of patients to note all the risk factors that can complicate the post-operative period of patients undergoing laparoscopic colorectal surgery for the better outcome.