A Clinical Study – Resection and Anastomosis of Bowel in Our Surgical Practice

Resection and Anastomosis of Bowel in Our Surgical Practice

Abstract

Background: Anastomotic leaks are among the most dreaded complications after bowel surgery. In the present era, even with better understanding of the impact of local and systemic factors on anastomotic healing, dehiscence and leakage remains frequent and serious problem associated with high morbidity and mortality. However, problems with definitions and the retrospective nature of previous analyses have been major limitations. The aim of the study to use a prospective database to study the incidence of intestinal resection and anastomoses, to determine important factors and their significance in the healing of the anastomosis along with identifying the most ideal suture material for these techniques in our practice. Subjects and Methods: This study was carried out on 40 patients who underwent resection and anastomosis of bowel for various pathological causes in Kamineni Institute of Medical Sciences & Hospital Hyderabad during September 2018 to September 2019. Results: Out of the 40 patients who underwent resection and anastomosis of bowel, Anastomotic leaks were observed in 10 (25%) cases and all of them belonged to the group who were operated on emergency basis. Hypoproteinaemia, peritonitis and perioperative blood transfusions, hypovolemia were important attributable factors identified in the leak group. Minimal leaks were observed in the group of patients who were anastomosed with vicryl suture material alone. Mortality was observed in 3patients in the leak group. At 6 month follow up none of them developed anastomosis related complications like stenosis, diverticulum. Conclusion: The present study shows majority of the patients undergoing resection and anastomosis were dealt on an emergency basis. Multivariate analysis showed six predictive variables i.e., serum albumin less than 3 g/l, use of corticosteroids, bacterial peritonitis, malignancy, COPD, perioperative blood transfusions had a higher risk of developing anastomotic leaks. Vicryl when used alone being the suture material of choice.