title: Increased risk of anastomotic leakage with diclofenac treatment after laparoscopic colorectal surgery.
abstract: BACKGROUND
  Over a period our department experienced an unexpected high frequency of anastomotic leakages. After diclofenac was removed from the postoperative analgesic regimen, the frequency dropped. This study aimed to evaluate the influence of diclofenac on the risk of developing anastomotic leakage after laparoscopic colorectal surgery.
  
  
  METHODS
  This was a retrospective case-control study based on 75 consecutive patients undergoing laparoscopic colorectal resection with primary anastomosis. In period 1, patients received diclofenac 150 mg/day. In period 2, diclofenac was withdrawn and the patients received an opioid analgesic instead. The primary outcome parameter was clinically significant anastomotical leakage verified at reoperation.
  
  
  RESULTS
  1/42 patients in the no-diclofenac group compared with 7/33 in the diclofenac group had an anastomotic leakage after operation (p = 0.018). In a multivariate regressional analysis, none of the recorded factors were significantly associated with the frequency of anastomotical leakages when diclofenac treatment was omitted from the model.
  
  
  CONCLUSIONS
  We found an increased number of clinically significant anastomotic leakages in patients receiving oral diclofenac for postoperative analgesia. There is an urgent need to test our hypothesis in prospective randomized clinical trials and to examine whether our findings can be extended to open surgery and to other NSAIDs.
authors.affiliation: Department of Surgical Gastroenterology D, Gentofte & Herlev Hospitals, University of Copenhagen, Niels Andersens Vej 65, Hellerup, Denmark. madsklein@hotmail.com
authors.forename: Mads
authors.initials: M
authors.lastname: Klein
authors.forename: Lars Peter Holst
authors.initials: LP
authors.lastname: Andersen
authors.forename: Thomas
authors.initials: T
authors.lastname: Harvald
authors.forename: Jacob
authors.initials: J
authors.lastname: Rosenberg
authors.forename: Ismail
authors.initials: I
authors.lastname: Gogenur
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D003108:Colonic Diseases / Q000601:surgery; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects*; D004008:Diclofenac / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007420:Intestine, Large / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012002:Rectal Diseases / Q000601:surgery
chemical_list: D016861:Cyclooxygenase Inhibitors; D004008:Diclofenac