Anastomotic Leak in Prepared Versus Unprepared Bowel

Abstract

Background: Patients undergoing bowel surgery for any reason are prone to develop peritonitis as a result of anastomotic leak. It is controversial whether bowel preparation before surgery can prevent this complication. The aim of this study was to measure the frequency of anastomotic leak in prepared compared to un-prepared bowel. Material & Methods: This quasi experimental Trial was conducted at Department of Surgery, C.M.H Rawalpindi, from Jan to Jul 2009. Ninety six patients were randomly allocated in two equal groups, A and B by lottery method. Patients of Group A were prepared with NGT irrigation of bowel with saline on the evening before surgery. Patients of Group B were not prepared. Patients were observed for anastomotic leak post operatively. Frequency and percentage were determined for Gender, TLC, peri anastomotic fluid, peri-anastomotic abscess and fistula. All the values were assessed using Chi-square to determine significance at p<0.05. Results: Mean age of sample was 41.46+8.15. There were was 52(54.2%) males and 44 (45.8%) females. Anastomotic leak was seen in 14/96 (14.6%) patients. Frequency of anastomotic leak in groups A & B was 8(16.7%) & 6(12.5%) respectively p=0.56. Difference in the raised TLC (p=1.0),peri-anastomotic free fluid (p=0.50), peri-anastomotic abscess formation (p=0.23), and peri-anastomotic fistula formation (p=0.55), was 27.1%(n=13), 12.5%(n=6), 10.4%(n=5), 4.2%(n=2) respectively in group A and 27.1%(n=13), 8.3%(n=4), 4.2%(n=2), 2.1%(n=1) in group B. Conclusion: There is no difference in frequency of leakage of bowel anastomosis whether it is performed in prepared or un-prepared bowel.