Ultimate fate of the leaking intestinal anastomosis: Does leak mean permanent stoma?

Todd D. Francone, Abdulaziz Saleem, Thomas A. Read, Patricia L. Roberts, Peter W. Marcello, David J. Schoetz, Rocco Ricciardi

Research output: Contribution to journalJournal articlepeer-review

21 Scopus citations


Background: The ultimate fate of the leaking intestinal anastomosis is unknown. We sought to analyze long-term outcomes of anastomotic leak with an emphasis on identifying the likelihood of re-establishing intestinal continuity and the potential for releak with corrective surgery. Methods: All consecutive subjects treated for clinical anastomotic leak from January 2001 through December 2007 were retrospectively reviewed. Patients were stratified by management of leak: (1) drainage alone, (2) proximal loop diversion, (3) repair/revision without diversion, (4) end stoma, or (5) tube enterostomy. We then determined management of anastomotic leak, mortality, corrective procedures, releak, and re-establishment of intestinal continuity. Results: In a database of 2,627 intestinal procedures, 79 patients had 88 anastomotic leaks with a final overall mortality of 10.1%. The aggregate rate of re-establishment of intestinal continuity was lowest for the patients treated by end stoma (44.4%) as compared to other initial management options (p > 0.01). Of the patients who survived their initial anastomotic leak, 20.5% had another leak (releak). Conclusions: Patients who underwent resection of the leaking anastomosis and end stoma or proximal loop diversion have a high rate of long-term fecal diversion. The proportion of patients who experience an anastomotic releak is substantial following further corrective surgery to re-establish intestinal continuity.

Original languageEnglish
Pages (from-to)987-992
Number of pages6
JournalJournal of Gastrointestinal Surgery
Issue number6
StatePublished - 2010
Externally publishedYes


  • Anastomosis
  • Gastrointestinal tract
  • Leak
  • Postoperative complication


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