211 Should primary anastomosis be feared less? A retrospective analysis of anastomotic complications in young children Chapter 9 Anastomotic leakage Anastomotic leakage was diagnosed in 5% (22/477) of the children after a median of 6 days (IQR: 3-7) following primary surgery. Diagnosis was made using abdominal radiograph (n=14), ultrasound (n=4), CT-scan (n=1) or during surgery (n=3). All leakages were ISREC classification C (“anastomotic leakage requiring re-laparotomy”). In Table 2 the occurrence of anastomotic leakages is described per condition. An anastomotic leakage developed in 6% (9/143) of the patients treated for intestinal atresias, in 2% (3/136) of the patients with Hirschsprung’s disease and 5% (3/67) of the patients treated for necrotizing enterocolitis. In the patients treated for intestinal atresia, 6% of the patients treated for a duodenum atresia (6/94) and jejunoileal atresia (3/49) developed a leakage. Half (3/6) of the leakages following treatment for duodenum atresia occurred from patients with a duodenal web treated by longitudinal incision, removal of the web and closure of the intestinal incision. Whilst four patients died following an anastomotic leakage, two patients died more than 100 days after redo-surgery due to factors non-related to the anastomotic leakage. The other two patient’s deaths were directly related to the anastomotic leakage resulting in a direct mortality of 9% (2/22) within all patients with a leakage and ≤ 1% (2/477) of all patients receiving a primary anastomosis. In one patient treated for a focal intestinal perforation the anastomotic leakage resulted in death before re-operation could be performed. Another patient with Down syndrome died ten days after treatment of a duodenal atresia. Following primary anastomosis, the patient developed an E. Coli sepsis as a result of an anastomotic leakage. Despite treatment by redo-anastomosis eight days after the initial surgery, the patient died as a result of ongoing sepsis. From the patients who underwent redo surgery because of anastomotic leakage a stoma was created in 50% (10/20), a new anastomosis in 50% (10/20). Both male gender (p = 0.03) and an ASA score ≥ III (p = 0.03) were significantly associated with anastomotic leakage.
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