title: Anastomotic leakage after anterior resection of the rectum.
abstract: OBJECTIVE
  To evaluate the results of elective colorectal operations, to identify factors that influence the anastomotic leak rate, and to assess the value of a covering colostomy.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  134 consecutive patients undergoing elective resection for a neoplasm (125 carcinomas and 10 villous adenomas) of the colon and rectum.
  
  
  METHODS
  135 operations (one for a recurrence in the anastomotic line).
  
  
  METHODS
  Morbidity and mortality.
  
  
  RESULTS
  Two patients died (1%) and there were 29 complications (21%); 16 patients developed clinical anastomotic leaks (12%) and 3 patients symptomatic strictures (2%). One patient who developed a leak died and 11 of the 16 (69%) were re-operated on. The rest settled spontaneously. The only significant risk factor associated with leakage was distance of the anastomosis from the anal verge (all 16 leaks were within 7 cm, compared with 44/118 without leaks, p < 0.001). Four patients who developed leaks were left with permanent colostomies. Protecting stomas had no significant influence, despite the fact that only 1 of those that developed leaks had a colostomy compared with 9/109 that did not.
  
  
  CONCLUSIONS
  Prospective controlled studies are needed to establish the true value of a covering colostomy after low colorectal anastomosis.
authors.affiliation: Second Department of Surgery, Helsinki University Central Hospital, Finland.
authors.forename: T E
authors.initials: TE
authors.lastname: Pakkastie
authors.forename: P E
authors.initials: PE
authors.lastname: Luukkonen
authors.forename: H J
authors.initials: HJ
authors.lastname: Järvinen
mesh_terms: D018253:Adenoma, Villous / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D003110:Colonic Neoplasms / Q000601:surgery; D003125:Colostomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012811:Sigmoid Neoplasms / Q000601:surgery*