Early diagnosis of anastomotic dehiscence after colonic surgery

BACKGROUND: Anastomotic leaks are often responsible for severe sepsis can lead to death. Rapid diagnosis and early intervention are needed to improve prognosis. AIM: To identify predictors of early diagnosis of anastomotic leakage after colonic resection followed by immediate anastomosis without protective stoma to ensure a rapid therapeutic care and improve prognosis. METHODS: This retrospective study involved patients who had a colonic resection over a period from 1st January 1998 to December 31st, 2009. The diagnosis of anastomotic dehiscence was selected on clinical, radiological and / or surgery. Statistical analysis was undertaken to identify clinical and biological changes leading to early diagnosis. The significance level was set at 0.05. RESULTS: Anastomotic leaks were identified in 28 patients, a rate of 8.9%. Revision surgery was indicated in 23 patients. Univariate analysis identified 3 preoperative factors associated with anastomotic dehiscence (ASA score, the urgency of intervention, and neoplastic etiology), and 5 postoperative factors (parietal complications, respiratory problems, the cardiac disorders, neurological disorders, and bloating). Multivariate analysis identified only three factors related to the anastomotic dehiscence, they were respiratory symptoms, bloating, and neurological disorders. The median length of stay was 15.6 days (5-84). The mortality rate was 1.2%. It was higher in patients with leakage (7.4%) than in patients without leakage (0.7%). CONCLUSION: Better knowledge of these early clinical and laboratory manifestations related to anastomotic leaks, can ask the early indication of a radiological drainage or reoperation, which can improve the prognosis of this dreaded disease.