From the Guidelines
The small bowel anastomotic leak rate is approximately 3% in trauma settings, as reported in recent studies 1. This rate can vary based on several factors, including the timing of anastomosis, the presence of other injuries, and the patient's haemodynamic status.
- Risk factors that increase leak rates include delayed primary anastomoses, open abdomens, and delays to fascial closure of more than five days 1.
- The use of indocyanine green fluorescent intraoperatively to predict anastomotic leak is a promising concept, but more research is needed to confirm its effectiveness 1.
- To minimize leak risk, surgeons should carefully weigh the risks and benefits of primary anastomosis versus diversion, taking into account the patient's overall condition and the presence of other injuries 1.
- Postoperative monitoring for signs of anastomotic leak is essential, including fever, increasing abdominal pain, tachycardia, leukocytosis, or drainage of intestinal contents from drains or the wound.
- Early recognition and intervention for leaks is critical, as delayed diagnosis significantly increases morbidity and mortality 1. The few studies that have reported outcomes of small bowel anastomosis in trauma settings have reported leak rates of about 3% in both the primary and delayed primary anastomosis patients 1.
From the Research
Small Bowel Anastomotic Leak Rate
- The small bowel anastomotic leak rate was found to be 4.9% in a study of 556 patients who underwent resection with anastomosis 2.
- Another study reported a leak rate of 35% in 74 emergency small bowel anastomoses 3.
- The leak rate for the highest-volume surgeons ranged from 1.6% to 9.9% (p <0.01) in the study by 2.
- Factors associated with anastomotic dehiscence in emergency small bowel anastomoses include hypoalbuminemia, hyponatremia at presentation, and intraoperative hypotension 3.
Diagnostic Imaging for Anastomotic Leaks
- CT scans and water-soluble enemas are commonly used diagnostic imaging modalities for detecting anastomotic leaks 4.
- A study found that water-soluble enema was superior to CT imaging in detecting distal anastomotic leaks, with a sensitivity of 88% compared to 12% for CT scans 4.
- The use of intraluminal contrast agent in CT scans was found to improve diagnostic performance in identifying anastomotic leaks 5.
Management and Outcome of Anastomotic Leaks
- Anastomotic leaks are associated with a high mortality rate, with an overall mortality of 27% reported in one study 6.
- The permanent stoma rate following a rectal anastomotic leak was found to be 27%, while it was 57.1% for colonic leaks 6.
- Reoperation was required in 14 out of 30 patients with anastomotic leaks, with 10 needing the anastomosis taken down 6.