title: What is the risk of clinical anastomotic leak in the diverted colorectal anastomosis?
abstract: OBJECTIVE
  The objective of this study was to identify clinical leak in diverted colorectal anastomoses.
  
  
  METHODS
  Cohort analysis.
  
  
  METHODS
  The study was conducted in a subspecialty practice at a tertiary care facility.
  
  
  METHODS
  Consecutive subjects undergoing colorectal anastomosis and proximal fecal diversion between July 16, 2007 and June, 31 2012.
  
  
  METHODS
  No intervention was applied.
  
  
  METHODS
  Clinical anastomotic leak.
  
  
  RESULTS
  Two hundred forty-five patients underwent a colorectal anastomosis with proximal fecal diversion. A total of 34 (14%) clinical leaks were identified at a median of 43 days. Clinical leaks were identified in 13 (5%) patients within 30 days of surgery (early leaks) and in 21 (9%) patients after 30 days of surgery (late leaks). Age, sex, use of neoadjuvant chemoradiotherapy, and method of anastomotic construction were similar in patients with clinical leaks as compared to those with no evidence of leak. However, clinical leaks were more likely to develop in patients with a diagnosis of inflammatory bowel disease or other diagnoses, i.e., radiation enteritis, ischemia, and injury/enterotomy. Patients with clinical leak were not more likely to have air leaks on intraoperative air leak testing.
  
  
  CONCLUSIONS
  In diverted anastomoses, most leaks become clinically apparent beyond 30 days. The standard practice of censoring outcomes that occur beyond postoperative day 30 will fail to identify a substantial fraction of leaks in diverted colorectal anastomoses.
authors.affiliation: Department of Colon and Rectal Surgery, Lahey Hospital & Medical Center, Tufts University Medical School, 41 Mall Road, Burlington, MA, 01805, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Leahy
authors.forename: David
authors.initials: D
authors.lastname: Schoetz
authors.forename: Peter
authors.initials: P
authors.lastname: Marcello
authors.forename: Thomas
authors.initials: T
authors.lastname: Read
authors.forename: Jason
authors.initials: J
authors.lastname: Hall
authors.forename: Patricia
authors.initials: P
authors.lastname: Roberts
authors.forename: Rocco
authors.initials: R
authors.lastname: Ricciardi
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D057868:Anastomotic Leak / Q000453:epidemiology*; D003106:Colon / Q000601:surgery*; D003108:Colonic Diseases / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012002:Rectal Diseases / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology