Magnitude and Associated Factors of Anastomotic leak in Colorectal Surgery at a Tertiary Care Hospital in Ethiopia: A five-year retrospective study

Abstract

Summary: Background: One of the most fatal consequences of intestinal surgery is an anastomotic leak. In the literature, there is no universally acknowledged definition of an anastomotic leak. The magnitude of anastomotic leakage has been observed to range between 0.5% and 21% after colorectal resections. Intraoperative transfusion, prolonged surgery (>3 hours), and emergency surgery are well-known factors for anastomotic leak. The frequency of clinically severe AL after colorectal surgery is much higher, with mortality rates ranging from 12% to 27%. Objective: is to assess the magnitude and associated factors for anastomotic leak after colorectal surgery. Methods: A 5-year retrospective cross-sectional study was done at St. Paul's Hospital Millennium Medical College, a teaching institution that also functions as a tertiary referral hospital in Addis Ababa, Ethiopia. All patients who experienced anastomotic leaks following colorectal surgery between 2018 and 2022 were evaluated. Data was gathered from patient charts and the OR log book using a data collection format. SPSS Statistics Version 25 was used to examine the data. The magnitude of leaks was determined, then pre-, intra-, and postoperative associated factors were identified and evaluated. Result: - A total of 270 patients were evaluated for anastomotic leak in the study period. 68.6% were male and 31.4 were female. The median age of patients were 45 years. Most of the patients 36.5% were from Oromia region. The magnitude of anastomotic leak in this study was slightly higher than the previous study finding in SPHMMC and accounts for 8.1%. A total of 137 patients had initial diagnosis of redundant sigmoid and 65.9% of all pathologies were benign. Sigmoidectomy was the commonest procedure performed on emergency and elective bases. Hypertension was the commonest comorbidity noticed among study group (15.1%). While majority of patients had ASA1 (71.6) it had no significant effect on outcome. Conclusion: In this study the magnitude of anastomotic leak following colorectal anastomosis was comparable to global and country data, even though malignant pathologies were found to have influence in AL and majority of patients operated were male, factors such as ASA, comorbidities, age and gender had no noticed effect on AL in our study. Keyword’s: Anastomotic leak, sigmoidectomy, hemicolectomy, colorectal anastomosis