Bowel anastomoses: The theory, the practice and the evidence base

Table 1 Patient factors affecting anastomotic healing

Positive factors

Negative factors

Good nutritional status[4] - low pre-operative albumen and recent weight loss of over 5 kg are independent risk factors for anastomotic leakage[5,6] Haemodynamic stability[7] Healthy bowel ends and microvasculature[7]

High-dose steroids[4] Old age[4] Anaemia - haemoglobin < 11g/dL is an independent risk factor for anastomotic leakage[4,6] Uraemia[4] Diabetes mellitus[4] Smoking[5] Alcohol abuse[5] High risk site of anastomosis (e.g., low colorectal anastomoses)[5] Pre-operative radiotherapy - results vary, but some studies have shown an increased anastomotic leak rate following anterior resection after long course radiotherapy[5] Male sex in colorectal anastomoses - presumably as the narrow pelvis results in poor visualisation and a more challenging operation[5]