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May 18, 2009

Anastomotic Leak Testing After Colorectal Resection: What Are the Data?

Author Affiliations

Author Affiliations: Department of Colon and Rectal Surgery, Lahey Clinic, Burlington, Massachusetts.

Arch Surg. 2009;144(5):407-411. doi:10.1001/archsurg.2009.43

Objective  To determine the value of anastomotic leak testing of left-sided colorectal anastomoses.

Design  Cohort analysis.

Setting  Subspecialty practice at a tertiary care facility.

Patients  Consecutive subjects were selected from a prospective colorectal database of 2627 patients treated between January l, 2001, and December 31, 2007.

Intervention  Creation of left-sided colorectal anastomoses and air leak testing per surgeon preference.

Main Outcomes Measures  Anastomosis type, method (handsewn vs stapled), performance of air leak testing, repair method of anastomoses after air leak tests yielding positive results, and development of postoperative clinical leak.

Results  A total of 998 left-sided colorectal anastomoses were performed without proximal diversion; 90.1% were stapled and 9.9% were handsewn. Intraoperative air leaks were noted in 65 of 825 tested anastomoses (7.9%), that is, 7.8% of stapled anastomoses and 9.5% of handsewn anastomoses. A clinical leak developed in 48 patients (4.8%). Clinical leaks were noted in 7.7% of anastomoses with positive air leak test results compared with 3.8% of anastomoses with negative air leak test results and 8.1% of all untested anastomoses (P < .03). If air leak testing yielded positive results, suture repair alone was associated with the highest rate of postoperative clinical leak compared with diversion or reanastomosis, 12.2% vs 0% vs 0%, respectively (P = .19).

Conclusions  Our data indicate a high rate of air leaks at air leak testing of left-sided colorectal anastomoses. In addition, the high rate of clinical leaks in untested anastomoses leads us to recommend air leak testing of all left-sided anastomoses, whether stapled or handsewn.