FACTORS ASSOCIATED WITH THE OCCURRENCE OF LEAKS IN STAPLED RECTAL ANASTOMOSES - A REVIEW OF 1,014 PATIENTS

Background: Despite improvement in surgical techniques and stapling de vices during the last 10 years, colorectal anastomoses are still prone to leakage. The purpose of this study was to assess the performance a nd safety of stapled anastomoses in rectal surgery and to identify fac tors that influence the occurrence of anastomotic leaks. Study Design: A review was undertaken of 1,014 patients who underwent stapled anast omoses to the rectum or anal canal for colorectal cancer or benign dis ease between 1989 and 1995 in a tertiary care institution. indications for operations, comorbidities at admission, preoperative bowel prepar ation, stapler size, intraoperative events, associated surgical proced ures, and clinical outcomes were tested for any association with anast omotic leak. Results: A double stapled technique was used in 154 patie nts and a conventional single stapler technique was used in 860. Posto perative mortality was 1.6%, and the overall morbidity was 18.4%. Clin ically apparent anastomotic leak developed in 29 patients (2.9%). Anas tomotic dehiscence occurred in 22 of 284 patients (1.7%) after low sta pling within 7 cm from the anal verge) and in 7 of 730 patients (1%) a fter high stapling (p < 0.001). Diabetes mellitus, use of pelvic drain age, and duration of surgery were significantly related to the occurre nce of anastomotic leak by the univariate analysis. Multivariate regre ssion analysis identified an anastomotic distance from the anal verge within 7 cm as the only variable related to the occurrence of postoper ative leak (p < 0.001).Conclusion: Low anastomoses were associated wit h a leak rate greater than with high colorectal anastomoses. We conclu de that anastomoses to the rectum using the circular stapler can be do ne with low mortality and morbidity. (C) 1997 by the American College of Surgeons.