Factores de riesgo predictores fístula anastomótica tras colectomía total o subtotal

Abstract

Introduction: Anastomotic leakage (AL) following ileorectal (IRA) or ileosigmoid (ISA) is associated with a high morbidity. The identificacion of potential risk factors to AL could change operative planning and reduce further complications. This study assesses rate, potential risk factors and management of AL after Total colectomy (TC) and subtotal colectomy (STC). Methods: A nationwide, multicentre, retrospective cohort study involved 26 Spanish referral centres. It included TC and STC with IRA or ISA patients between January 2013 and December 2020. Clinical data, primary surgery and complications were collected. Univariate and multivariate analysis to identify risk factors to AL were performed. Management of grade B-C AL and permanent stoma rate was assessed according to revisional surgeries. Results: Study included 1074 patients, 433 ISA group (40.3%) and 641 IRA group (59.7%). Overall incidence of AL was 14.3% with no differences between IRA and ISA (14.2% and 14.5% respectively), p=0.871. Male sex (p=0,032; OR:1,06 (CI 95% 1,04-2,2), ASA score (p=0,015, OR: 1,83 CI 95% 1,12-2,99) and lower total preoperative proteins (p=0,042 OR:1,10 CI 95% 1,05-1,20) were identified as independent risk factors to global and grade B-C AL. Diverting ileostomy did not protect against AL (p=0.084). Clavien-Dindo >IIIA complication was found in 251 patients (23,3%). Stoma reversal was not possible in 85 patients (8.1%), being more frequent after anastomosis excision and terminal ileostomy in AL grade C. Conclusion: TC and STC with IRA or ISA is a high-risk procedure with an increased AL rate. Male sex, ASA score and lower preoperative proteins level were associated with global AL and AL grade B and C. Lower permanent stoma rate could be obtained when diverting ileostomy is performed in revision surgery.