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Diseases of the Colon & Rectum
Published in: Diseases of the Colon & Rectum 10/2006

01-10-2006

Clinical and Subclinical Leaks After Low Colorectal Anastomosis: A Clinical and Radiologic Study

Authors: Michael Lim, M.R.C.S., Saleem Akhtar, F.R.C.S., Kishore Sasapu, F.R.C.S., Keith Harris, F.R.C.S., Dermot Burke, Ph.D., F.R.C.S., Peter Sagar, M.D., F.R.C.S., Paul Finan, M.D., F.R.C.S.

Published in: Diseases of the Colon & Rectum | Issue 10/2006

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Purpose

This study was designed to examine the natural history of subclinical leaks and their effect on bowel function and quality of life and to evaluate water-soluble contrast enema features that predict anastomotic healing after leaks.

Methods

Consecutive patients who underwent low rectal anastomosis were followed up postoperatively for leaks. All leaks were confirmed radiologically with CT scanning and water-soluble contrast enema imaging. Water-soluble contrast enemas were serially repeated to identify healing. Characteristics on initial water-soluble contrast enema were correlated with observed healing. Postoperatively, patients were required to fill in a quality of life and a bowel function questionnaire.

Results

A total of 138 patients underwent low rectal anastomosis procedures with a median follow-up period of 26 (interquartile range, 19–37) months. There were 23 documented leaks of which 13 (9 percent) presented clinically and 10 (8 percent) presented subclinically. Ileostomy closure was possible in 4 of 13 (30 percent) patients with a clinical leak and all 10 (100 percent) patients with a subclinical leak. Median quality of life scores were lower for patients with clinical leaks and no ileostomy closure (P = 0.03). Bowel function for subclinical leak patients and clinical leak patients with ileostomy closure were similarly impaired. The presence of a cavity (P = 0.01) and a stricture (P = 0.01) at the anastomotic site were unfavorable radiologic features associated with nonhealing.

Conclusions

Subclinical leaks are more benign in their natural history compared with clinical leaks. Quality of life and bowel function is no better in patients with a subclinical leak compared with patients with a clinical leak who have ileostomy closure. Anastomotic leaks may resolve if favorable radiologic features are present.
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Metadata
Title
Clinical and Subclinical Leaks After Low Colorectal Anastomosis: A Clinical and Radiologic Study
Authors
Michael Lim, M.R.C.S.
Saleem Akhtar, F.R.C.S.
Kishore Sasapu, F.R.C.S.
Keith Harris, F.R.C.S.
Dermot Burke, Ph.D., F.R.C.S.
Peter Sagar, M.D., F.R.C.S.
Paul Finan, M.D., F.R.C.S.
Publication date
01-10-2006
Publisher
Springer-Verlag
Published in
Diseases of the Colon & Rectum / Issue 10/2006
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI
https://doi.org/10.1007/s10350-006-0663-6

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