The Incidence of Anastomotic Leak in Elective High Anterior Resection for Diverticular Disease vs. Neoplasia

Author(s): Ankur Sidhu, Kiran Narula, Eric Daniel, Marina H Wallace, Gregory Makin

Background: There is a paucity of data comparing the incidence of anastomotic leak (AL) between resections for diverticular disease (DD) and neoplasia (NN). We compared the incidence of anastomotic leak in open or laparoscopic high anterior resections (HAR) between DD and NN.

Methodology: A retrospective review of prospectively collected data was performed on patients presenting to Fremantle Hospital, Fiona Stanley Hospital and St. John of God Hospital, Murdoch between 2007 and 2016 for an elective HAR. Data in relation to patient demographics, method of operation, morbidity, mortality, length of stay and anastomotic leak was collected and analysed.

Results: A total of 534 patients were identified with 340 patients undergoing a high anterior resection for NN and 194 patients for DD. The incidence of anastomotic leak for the NN and DD groups were 4.7% (n=16) and 7.2% (n=14) respectively (p 0.244) with an overall incidence of 5.6% (n =30). Two patients in each group were treated with antibiotics; all others were returned to theatre for operative intervention. The median length of stay for patients in the NN group was 5 days compared to 6 days for the DD group (p=0.304). In-hospital mortality for patients in the NN and DD groups were 0.03% (n=1) and 1.0% (n=2), respectively (p=0.300).

Conclusion: An elective high anterior resection for diverticular disease can be performed safely with acceptable rates of morbidity and mortality.