Editorial
Copyright ©2012 Baishideng Publishing Group Co.
World J Gastrointest Surg. Sep 27, 2012; 4(9): 208-213
Published online Sep 27, 2012. doi: 10.4240/wjgs.v4.i9.208
Table 1 Patient factors affecting anastomotic healing
Positive factorsNegative 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]
Table 2 Technical factors affecting anastomotic healing
Positive factorsNegative factors
Accurate seromuscular apposition[3,7]Faecal contamination[5,7]
No distal obstruction[7]Haematoma formation[5,7]
Closure of the mesenteric window[3,7]
Table 3 Levels of evidence
Level 1aEvidence from meta-analysis of randomised controlled trials
Level 1bEvidence from at least one randomised controlled trial
Level 2aEvidence from at least one controlled study without randomisation
Level 2bEvidence from at least one other type of quasi-experimental study
Level 3Evidence from non-experimental descriptive studies, such as comparative studies and case-controlled studies
Level 4Evidence from expert committee reports or opinions or clinical experience of respected authorities, or both