Leaks

This study is a retrospective review of over 70,000 low anterior resections, nationwide, from the years 2006-2009. Results The AL rate was 13.68%. The AL group had higher mortality vs the non-AL group (1.78% vs 0.74%). Hospital length of stay and cost were significantly higher in the AL group. Laparoscopic and open resections with a diverting stoma had a higher incidence of AL than those without a stoma (15.97% vs 13.25%). Multivariate analysis revealed that weight loss and malnutrition, fluid and electrolyte disorders, male sex, and stoma placement were associated with a higher risk of AL. The use of laparoscopy was associated with a lower risk of AL. Postoperative ileus, wound infection, respiratory/renal failure, urinary tract infection, pneumonia, deep vein thrombosis, and myocardial infarction were independently associated with AL.An anastomotic leak is truly a malevolent, disruptive event.  Foremost, the patient suffers.  Sometimes you can get away with treating a small leak non-operatively, with drains, bowel rest and antibiotics.  But more often than not, the patient has to go back to the OR emergently, under less than ideal circumstances.  Most commonly, they end up with a colostomy or some form of intestinal diversion.  The abdominal sepsis that results can set off a chain reaction of pathophysiology leading to multiple organ failure and even death.  And if the unfortunate soul survives the acute leak, then,...
Source: Buckeye Surgeon - Category: Surgery Authors: Source Type: blogs