Long-term and Perioperative Corticosteroids in Anastomotic Leakage A Prospective Study of 259 Left-Sided Colorectal Anastomoses

Juliette Slieker, N Komen, GH Mannaerts, TM Karsten, P Willemsen, Magdalena Murawska, J (Hans) Jeekel, Johan Lange

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Abstract

Objective: To determine the risk factors for symptomatic anastomotic leakage (AL) after colorectal resection. Design: Review of records of patients who participated in the Analysis of Predictive Parameters for Evident Anastomotic Leakage study. Setting: Eight health centers. Patients: Two hundred fifty-nine patients who underwent left-sided colorectal anastomoses. Intervention: Corticosteroids taken as long-term medication for underlying disease or perioperatively for the prevention of postoperative pulmonary complications. Main Outcome Measures: Prospective evaluations for risk factors for symptomatic AL. Results: In 23% of patients, a defunctioning stoma was constructed. The incidence of AL was 7.3%. The clinical course of patients with AL showed that in 21% of leaks, the drain indicated leakage; in the remaining patients, computed tomography or laparotomy resulted equally often in the detection of AL. In 50% of patients with AL, a Hartmann operation was needed. The incidence of AL was significantly higher in patients with pulmonary comorbidity (22.6% leakage), patients taking corticosteroids as Conclusions: We found a significantly increased incidence of AL in patients treated with long-term corticosteroids and perioperative corticosteroids for pulmonary comorbidity. Therefore, we recommend that in this patient category, anastomoses should be protected by a diverting stoma or a Hartmann procedure should be considered to avoid AL.
Original languageUndefined/Unknown
Pages (from-to)447-452
Number of pages6
JournalArchives of Surgery
Volume147
Issue number5
DOIs
Publication statusPublished - 2012

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