EP403 - Does Ileorectal/Ileosigmoid Anastomotic Configuration Affect Anastomotic Leak Rate?

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Purpose/Background: Ileorectal and ileosigmoid anastomoses are associated with higher rates of anastomotic leakage, in comparison to ileocolic or colorectal anastomoses. The most commonly performed anastomotic configurations are end-to-end, end-to-side and side-to-side. There is a paucity of studies examining whether anastomotic configurations affect leak rates. Additionally, it is unclear which patient or operative-related factors are associated with this higher risk.

Methods/Interventions: This is a retrospective chart review of all patients who underwent laparoscopic, robotic or open total abdominal colectomy with re-anastomosis in either 1 or 2 stages. The procedures were performed between January 2009 and December 2023 within a single colorectal surgery department at a single institution. Patients were divided into groups based on anastomotic configuration. Our primary aim was to compare leak rates between the anastomotic configurations. Data including patient demographics, operative details and 30-day postoperative outcomes were extracted from electronic medical records. Categorical variables were analyzed using a Chi-squared test and continuous variables were analyzed using a one-way ANOVA test.

Results/Outcomes: A total of 199 patients were included that underwent total abdominal colectomy with ileorectal or ileosigmoid anastomosis by 8 different colorectal surgeons. Overall, the mean age was 49 years (range: 18-79), 60% were female, most anastomoses were performed electively (89%) and done in a single stage (75%). The most common indication for total abdominal colectomy was for malignancy/polyposis syndromes (74%). The most common anastomotic configuration was end-to-end (50%), followed by side-to-side (29%), then end-to-side (21%). The three groups were similar in terms of BMI, sex, open and emergent cases, ASA, operative time and estimated blood loss. There were significant differences in age (p = 0.005), indication (p = < 0.009), two-staged approach (p= < 0.0004), Charlson Comorbidity Index score (p = < 0.0003), length of stay (p = 0.0002) and 30-day morbidity rate (p = < 0.0009). Anastomotic leaks occurred in 18.9% of side-to-side, 17% of end-to-side and 7% of end-to-end anastomoses; however, these differences were not statistically significant (p = 0.06).

Conclusion/Discussion: Although our data demonstrates a non-significant difference in anastomotic leak rates in regard to anastomotic configuration, there is significant heterogeneity between the age and indications between groups. While there may be benefits in length of stay and 30-day morbidity between groups, further studies with a larger sample size are needed to elucidate the association between anastomotic configuration and leak rate.