Abstract

*Dr. Ajinkya N. Puppal and Dr. A. Y. Kshirsagar

ABSTRACT

Background and objective: Bowel anastomosis is the surgical procedure done in order to establish communication between two formerly distant portions of the bowel. This surgical procedure restores bowel continuity after the removal of a pathological condition affecting the intestines. A dangerous complication of bowel anastomosis is anastomotic leak causing peritonitis, which is related with a high morbidity and mortality. Good surgical technique and obedience to fundamental principles is vital to ensure successful outcome after bowel anastomosis. Safety in the gastrointestinal surgery may therefore depends to a great extent on the factors that affect the healing of anastomosis. Our information of the gastrointestinal surgery has developed slowly over centuries from a mystical to a scientific level over many eras. Today, surgeries on the gastrointestinal tract are among the most frequent surgical procedures. Our information of the gastrointestinal healing has progressed and we have better understanding of the influence of local and systemic factors on anastomotic healing. Nonetheless, anastomotic leak and dehiscence continue to be recurrent and serious difficulties related with high morbidity and mortality. This study was designed to identify risk factors for anastomotic leakage following bowel anastomosis, to study the incidence of early complications after bowel anastomosis and to study mortality rates for bowel anastomosis. Methods: This study is the prospective hospital based time bound study concerning all patients undergoing Intestinal Resection and Anastomosis at Krishna Institute of Medical Sciences from 1st December of 2016 to 30th June of 2018. Information was collected from detailed history, clinical examination and investigations (both hematological and radiological investigations) on the patients. A total of 50 patients undergoing resection and anastomosis for different diseases were studied. Results: In present study, there were 30 male patients (60%) and 20(40%) female patients. The age of the patients in this study ranged from 18 to 85 years. 43(86%) patients underwent anastomosis in the emergency setting and 7(14%) underwent anastomosis in elective setting. In this study out of 50 total patients, 46 patients (92%) underwent end to end anastomosis, 2 patients (4%) underwent end to side anastomosis and 2 patients (4%) underwent side to side anastomosis. The risk factors which are known to influence the outcome of bowel anastomosis particularly the occurrence of the anastomotic leak were observed and recorded including age, anaemia, hypoalbuminaemia, emergency surgery, peri-operative use of steroids, and intra-abdominal sepsis. The anastomotic leak rate was 27.77%, 40%, 40%, 23.25%, 42.85% and 37.5% respectively. The incidence of early post op complications including surgical site infections, anastomotic disruptions, septicaemia, acute renal failure, respiratory complications and abdominal wound dehiscence were 33%, 22%, 30%, 8%, 30% and 4% respectively. Interpretation and Conclusion: Bowel anastomosis conveys a substantial mortality and the morbidity. Emergency small bowel anastomoses and intra abdominal sepsis carry a high risk of anastomotic leak despite detail to technical details during construction. Anastomotic leak rate is not effected by the kind of anastomosis used. Malnourished (with low serum albumin levels) patients are at a high risk for developing anastomotic leak, surgical site infection, morbidity and mortality following intestinal anastomosis. Serum albumin levels can be used as an easy, reliable and economical prognostic pointer in predicting the result of bowel anastomoses. This can be valuable to the surgeon in surgical decision making as well as explanation of the prognosis and surgical risk to the patient. Patients with intra-abdominal sepsis as well as patients treated with perioperative steroids for pulmonary co-morbidity convey a significant risk for anastomotic leak. Therefore in this patient group, it is suggested that anastomoses should be protected by a diverting stoma or Hartmann procedure must be considered to avoid Anastomotic dehiscence.