Repeated Treatments for Chronic Colorectal and Coloanal Anastomotic Leaks are Associated With a Higher Chance of a Permanent Stoma

Abstract

Background

We aimed to identify risk factors associated with chronic anastomotic leak (AL) treatment failure.

Methods

Adult patients surgically treated for chronic AL after colorectal or coloanal anastomosis for benign and malignant indications were included. The primary outcome was predictors of AL treatment failure, defined as failure to restore bowel continuity and/or having a permanent stoma at completion of treatment. Step-wise multivariable logistic regression analysis of factors that reached statistical significance on univariable analyses was undertaken.

Results

60 patients [41 (68.3%) males; average age: 56 (SD 6.7) years; and average BMI: 24 (SD 2.1) kg/m²] were included. 61% of patients were referred for treatment; 46 (76.7%) had colorectal and 14 (23.3%) had coloanal anastomosis at index surgery. 38 (63.3%) had successful treatment; 22 (36.7%) required permanent stoma. Patients who failed treatment on univariable analysis were likely older (OR 1.06; P = 0.045), had >2 prior attempted AL treatments (OR 9.53; P = 0.042), and end colostomy at AL surgery (OR 25.4; P = 0.032). Predictors of failed treatment of chronic AL on multivariable analysis were older age and >2 prior treatments.

Conclusion

More than 1/3 of patients with chronic AL eventually fail to achieve restored intestinal continuity. Risk factors on multivariable regression are >2 treatments for chronic AL before definitive therapy and older age at treatment. We recommend considering redoing the anastomosis earlier in the treatment of chronic AL.