Anastomotic Leak in Prepared Versus Unprepared Bowel

Muhammad Uzair Ilyas Tahirkheli, Irfan Shukr, Raja Azhar Iqbal


Background: Patients undergoing bowel surgery for any reason are prone to develop peritonitis as a result of anastomotic leak. It is controversial whether bowel preparation before surgery can prevent this complication. The aim of this study was to measure the frequency of anastomotic leak in prepared compared to un-prepared bowel. Material & Methods: This quasi experimental Trial was conducted at Department of Surgery, C.M.H Rawalpindi, from Jan to Jul 2009. Ninety six patients were randomly allocated in two equal groups, A and B by lottery method. Patients of Group A were prepared with NGT irrigation of bowel with saline on the evening before surgery. Patients of Group B were not prepared. Patients were observed for anastomotic leak post operatively. Frequency and percentage were determined for Gender, TLC, peri anastomotic fluid, peri-anastomotic abscess and fistula. All the values were assessed using Chi-square to determine significance at p<0.05. Results: Mean age of sample was 41.46+8.15. There were was 52(54.2%) males and 44 (45.8%) females. Anastomotic leak was seen in 14/96 (14.6%) patients. Frequency of anastomotic leak in groups A & B was 8(16.7%) & 6(12.5%) respectively p=0.56. Difference in the raised TLC (p=1.0),peri-anastomotic free fluid (p=0.50), peri-anastomotic abscess formation (p=0.23), and peri-anastomotic fistula formation (p=0.55), was 27.1%(n=13), 12.5%(n=6), 10.4%(n=5), 4.2%(n=2) respectively in group A and 27.1%(n=13), 8.3%(n=4), 4.2%(n=2), 2.1%(n=1) in group B. Conclusion: There is no difference in frequency of leakage of bowel anastomosis whether it is performed in prepared or un-prepared bowel.


Bowel anastomosis; Bowel Preparation; Anastomotic leak

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Thompson J. The peritoneum, omentum, mesentery and retroperitoneal space. In: Russel RCG, William NS, Bulstrode CJK, editors. Bailey and Love's Short Practice of Surgery. 25th ed. London: Arnold; 2008. p. 991-1008.

Robert DF, Najjia M, David JM, Howard MR, John R. Bowel preparation before surgery. In: Daniel Beauchamp, B Mark Evers, Kenneth L., Mattox, editors. Sabiston Textbook of Surgery. 17th ed. Philadelphia: Elsevier; 2004. p. 1415-7.

Arnspiger RC, Helling TS. An evaluation of results of colon anastomosis in prepared and unprepared bowel. J ClinGastroenterol 1988;10:638-41.

Lodhi FB, Farooq T, Shafiq M, Hussain R. Anastomotic leak after small gut surgery. Professional MedJ 2006; 13: 47-50.

Ali M. Randomized prospective clinical trial of no preparation versus mechanical bowel preparation before elective colorectal surgery. Med Channel 2007;13:32-5.

Bucher P, Gervaz P, Soravia C, Mermillod B, Erne M, Morel P. Randomized clinical trial of mechanical bowel preparation versus no preparation before elective left-sided colorectal surgery. Br J Surg 2005;92:409-14.

Haris A, Demeter P, Toth I, Polner K. Severe hyponatremia and comatose state during colonoscopy preparation. OrvHetil 2010; 151: 828-31.

Belsey J, Epstein O, Heresbach D. Systematic review: adverse event reports for oral sodium phosphate and polyethylene glycol. Aliment PharmacolTher 2007; 25: 373-84.

Chaleoykitti B. Comparative study between polyethylene glycol and sodium phosphate solution in elective colorectal surgery. J Med Assoc Thai 2002; 85: 92-6.

Tan JJ, Tjandra JJ. Which is the optimal bowel preparation for colonoscopy - a meta-analysis. Colorectal Dis. 2006 ;8: 247-58.

Boulos PB, Bichere AO. Complications of Colorectal Surgery. In: Nadey S.Hakim, Vassilios E.Papalois, editors. Surgical Complications Diagnosis and Treatment. 2007. p363-90.

Kingham TP, Pachter HL. Colonic anastomotic leak: risk factors, diagnosis, and treatment. J Am CollSurg 2009; 208: 269-78.

Telem DA, Chin EH, Nguyen SQ, Divino CM. Risk factors for anastomotic leak following colorectal surgery: a case-control study. Arch Surg2010 ;145: 371-6.

Fa Si Oen, Roumen, Buitenweg, Van De Velde, Van Geldere, Putter H, et al. Mechanical bowel preparation or not? Outcome of a multicenter, randomized trial in elective open colon surgery. Dis Colon Rectum 2005;48:1509-16.

Ram E, Sherman Y, Weil R, Vishne T, Kravarusic D, Dreznik Z. Is mechanical bowel preparation mandatory for elective colon surgery? A prospective randomized study. Arch Surg 2005;140:285-8.

Zmora O, Mahajna A, Bar-Zakai B, Hershko D, Shabtai M, Krausz MM, et al. Is mechanical bowel preparation mandatory for left-sided colonic anastomosis? Results of a prospective randomized trial. Tech Coloproctol 2006;10:131-5.

Iqbal P, Saddique M, Umair-ul-Islam. Leakage of colorectal anastomosis. Experience at civil hospital karachi. Pakistan Journal of Surgery 2007;23:169-72.

Croucher LJ, Bury JP, Williams EA, Riley SA, Corfe BM. Commonly used bowel preparations have significant and different effects upon cell proliferation in the colon: a pilot study. BMC Gastroenterol 2008; 8: 54.

Bucher P, Gervaz P, Egger JF, Soravia C, Morel P. Morphologic alterations associated with mechanical bowel preparation before elective colorectal surgery: a randomized trial. Dis Colon Rectum 2006;49:109-12.

Pena-Soria MJ, Mayol JM, nula-Fernandez R, rbeo-Escolar A, Fernandez-Represa JA. Mechanical bowel preparation for elective colorectal surgery with primary intraperitoneal anastomosis by a single surgeon: interim analysis of a prospective single-blinded randomized trial. J GastrointestSurg 2007;11:562-7.

Nasir M, Khan IA. Resection and primary anastomosis in the management of acute sigmoid volvulous. Pakistan Journal of Surgery 2008; 24: 95-7.

Guenaga KK, Matos D, Wille-Jorgensen P. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev 2009;(1):CD001544.

Slim K, Vicaut E, Launay-Savary MV, Contant C, Chipponi J. Updated systematic review and meta-analysis of randomized clinical trials on the role of mechanical bowel preparation before colorectal surgery. Ann Surg 2009;249:203-9.

Scabini S, Rimini E, Romairone E, Scordamaglia R, Damiani G, Pertile D, et al. Colon and rectal surgery for cancer without mechanical bowel preparation: One-center randomized prospective trial. World J SurgOncol 2010;8:35.

Rodriguez-Ramirez SE, Uribe A, Ruiz-Garcia EB, Labastida S, Luna-Perez P. Risk factors for anastomotic leakage after preoperative chemoradiation therapy and low anterior resection with total mesorectal excision for locally advanced rectal cancer. Rev Invest Clin 2006; 58: 204-10.


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