Anastomotic leak rate and outcome for laparoscopic intra-corporeal stapled anastomosis

OBJECTIVES A prospective audit of all patients undergoing laparoscopic surgery with the intention of primary colonic left-sided intracorporeal stapled anastomosis to identify the clinical anastomotic leak rate on an intention to treat basis. METHODS All patients undergoing laparoscopic colorectal surgery resulting in left-sided stapled anastomosis were included. All operations were conducted by the same surgical team with the same pre-operative preparation and surgical technique. The factors analysed for this audit were patient demographics (age and sex), indication for operation, procedure performed, height of anastomosis, leak rate and the outcome, inpatient stay, mortality, rate of defunctioning stomas, and rate of conversion to open procedure. RESULTS Eighty-four patients (49 females, 35 males; median age 70 years, range 19-89 years) underwent colonic procedures with left-sided intracorporeal stapled anastomosis. An intra-operative air leak was evident in one patient, whose anastomosis was oversewn intracorporeally and defunctioned by ileostomy. There were only two clinically evident anastomotic leaks post-operatively (2.9%). One patient died of overwhelming sepsis within 48h of re-operation: Seven patients (8.3%) had a primary defunctioning stoma, with two further stomas formed due to anastomotic leakage. Five cases (6%) were converted to open surgery. The median post-operative stay was six days, range 2-23. Thirty-day mortality was 50% in the leak group and 0% in the non-leak group. CONCLUSION We believe that this study demonstrates that the anastomotic leak rate from intra-corporeal laparoscopic anastomosis is no greater than for open surgery or laparoscopic surgery with extra-corporeal anastomosis.