Anastomotic Leak Following High Anterior Resection and Diverticular Disease as a Risk Factor

We have noticed high rate of anastomotic failure following high anterior resection in particular patients with diverticular disease and those who had meso-rectal excision for cancer of the rectum. We assessed the effect of those factors on the rate of anastomotic leak following anterior resection. All patients who had anterior resection at Auckland Hospital from 1992-2003 were reviewed for factors that can have effect on anastomotic leak. The effect of gender, age, level of anastomosis, diverticular disease and mesorectal excision was analyzed. There were 160 anterior resections. Leak was seen in 14% of those who had high anastomosis (above the peritoneal reflection), 7.6% in patients with ultra-low anastomosis (less than 6 cm from the anal verge) and 4% in patients with anastomosis between 6-10 cm above the anal verge. Multivariate analysis showed diverticular disease and meso-rectal excision were the only independent risk factors for leak following high anterior resection (more than 6 cm above the anal verge). High anterior resection has the highest risk of anastomotic failure in patients with diverticular disease and those who had meso-rectal excision.