Clinical anastomosis leakage and determinant factors among patients who had intestinal anastomosis in two Ethiopian tertiary hospitals

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This study aimed to identify the rate, determinant factors, and outcomes associated with anastomotic leakage for patients undergo gastrointestinal anastomoses in two major hospitals in Addis Ababa, Ethiopia. Method: A retrospective cross-sectional study used and 206 patients who underwent bowel anastomosis between 2016 and 2019 GC. To asses Determinant factor first bivariate analysis was done for all independent variables and for variables with P. value < 0.2 multiple logistic regresion was performed to identify independent predictors of anastomotic leakage. Odds ratios were computed, and a p-value <0.05 was considered statistically significant and Hosmer-Lemeshow goodness-of-fit test was run to ascertain the fitness of the model Results: The clinical anastomotic leak (AL) rate in this study was 8.3%. The presence of gangrenous bowel at the time of surgery was a strong independent predictor of AL (AOR 4.88; 95% CI: 1.62–14.69; p < 0.001). Intraoperative blood loss greater than 500 mL was also significantly associated with an increased risk of leakage (AOR 3.13; 95% CI: 1.07–9.17; p = 0.029). Moreover, patients who developed anastomotic leakage had a higher risk of mortality (AOR 5.495; 95% CI: 1.517–20.00; p = 0.004). The presence of AL was additionally associated with prolonged hospital stay beyond 20 days (AOR 5.49; 95% CI: 1.99–7.12; p = 0.000). 3.13; (1.07–9.17) Conclusion: In this study, anastomotic leakage was found to be higher than expected. Bowel viability and the amount of blood loss were significant predictors of clinical anastomotic leakage. Additionally, the presence of anastomotic leakage was associated with increased mortality and prolonged hospitalization. Anastomotic leak risk factors predictors or surgical complications Figures Figure 1 Background Intestinal anastomosis plays a vital role in restoring bowel continuity after resection and is frequently utilized in various surgical scenarios. Both elective and emergency procedures rely heavily on the integrity of the anastomosis for favorable outcomes. Pioneering surgical techniques, refined over time, have aimed to optimize healing and minimize complications such as leakage [ 1 , 2 ]. Nevertheless, Intestinal anastomotic leakage (AL) continues to be among the most serious and feared complications following gastrointestinal surgery. It is typically defined as a breakdown at the anastomotic site leading to leakage of intestinal contents into the abdominal cavity. This event is not only a major cause of surgical morbidity but also significantly contributes to mortality and resource utilization [ 3 , 4 ]. Multiple factors contribute to the risk of AL, including impaired perfusion, infection, tension on the anastomosis, and systemic conditions such as anemia, malnutrition, and diabetes mellitus. Technical errors during surgery may further exacerbate the risk [ 8 – 10 ]. The incidence of AL varies considerably by procedure type, with colorectal surgeries often having the highest risk for some estimates reporting up to 26% leakage rates [ 7 ]. These leaks may range in presentation from fulminant peritonitis to insidious signs such as fever or delayed gastrointestinal function, typically surfacing around the fifth to seventh postoperative day [ 11 , 13 ]. Delayed diagnosis is particularly problematic in settings with limited diagnostic resources, where subtle clinical changes may be overlooked. Furthermore, early discharge in cost-conscious systems may prevent timely recognition and intervention, increasing the likelihood of complications and readmissions [ 16 , 17 ]. The scarcity of context-specific data in Ethiopia has hindered progress in understanding and managing AL. This research aims to fill that gap by evaluating the frequency and associated clinical factors of AL in two major referral hospitals in Addis Ababa. The findings are expected to provide a foundational understanding for improving clinical decision-making, reducing postoperative complications, and guiding policy reforms aimed at enhancing surgical care quality. Materials and Methods Study Area This study was conducted in two major referral hospitals located in Addis Ababa, Ethiopia: Zewditu Memorial Hospital (ZMH) and Yekatit 12 Hospital (YMH). These institutions were chosen due to their high surgical case volume and their critical role in serving a large population in both urban and peri-urban areas. ZMH, situated on Taitu Street, is a public hospital offering a range of medical services, including approximately 10 major surgical procedures per day. With more than 6,000 outpatient visits each month, it is a key facility for the city and its surroundings. YMH is a specialized tertiary care center that manages complex surgical cases and provides multidisciplinary care involving departments such as surgery, in5ternal medicine, and intensive care. It serves an estimated catchment population of over five million people. Study Design, and Period A hospital-based retrospective cross-sectional study was conducted and data collection was undergone from March 2021to June 2021. The study reviewed patients who underwent intestinal anastomosis surgery between 2016 and 2019. Study Population All patients who full filled the inclusion criteria during the study period at ZMH and YMH. Inclusion and Exclusion criteria. Inclusion criteria Patient in all age Patients with confirmed diagnosis of clinical anastomosis leakage Patients whose outcome is known Exclusion criteria Underwent primary closure of small bowel perforations without bowel resection, Received only stoma formation with proximal diversion without definitive resection, or Were referred from other institutions already presenting with postoperative complications such as leakage, intra-abdominal abscesses, or enterocutaneous fistulas. Sample Size, Determination and Sampling Procedure Using a lottery method, two hospitals were randomly selected from six high-volume facilities. Subsequently, convenient sampling was employed to recruit patients who met the inclusion criteria. A total of 224 patients were initially included. After excluding 18 cases due to incomplete or missing data, the final analysis comprised 206 patients. No formal sample size calculation was performed; instead, all eligible patients presenting during the study period were consecutively included to maximize the available sample size and ensure adequate representation. Variables The dependent variable was clinical anastomotic leakage (AL), defined as a leak diagnosed by a physician and confirmed by documentation of re-laparotomy or discharge records. Independent variables included: Socio-demographic Age, sex, marital status, alcohol and smoking history Pre-operative Comorbidities, ASA classification, diagnosis, hematocrit, and creatinine levels Intra-operative Type and duration of surgery, blood transfusions, surgical technique, anastomosis location and number, drain usage Post-operative Complications, hematocrit, sodium, potassium, and creatinine levels Operational Definitions Clinical anastomosis leakage Leakage identified by the attending physician with supporting documentation of reoperation or discharge notes [3]. Low ATL rate Leakage rate under 4.9% [7] High ATL rate Leakage rate over 7.2% [7] Data Collection Tool and Quality Control Data were collected using a structured checklist developed after reviewing relevant literature and sample patient charts. The checklist was pretested on 5% of the intended sample size to identify and correct ambiguities. Feedback led to refinements in the tool. Six trained data collectors and three supervisors participated, following a one-day training workshop. The principal investigator conducted regular supervision and data quality audits. Data Processing and Analysis Data were entered and cleaned using EpiData version 4.6 and then exported to SPSS version 25 for analysis. Descriptive statistics were generated for key variables first. To asses’ determinant factors for AL, all independent variables were analyzed using bivariate analysis, and variables with a p-value < 0.2 were entered into multivariate logistic regression. Statistical significance was determined at p 0.05 indicates data fitness. Results were reported using odds ratios with 95% confidence intervals. Ethical Considerations Ethical clearance was obtained from the Ethical Review Committee of the College of Health Sciences at Addis Ababa University. Institutional permissions were secured from hospital authorities. As the study used secondary data, patient consent was waived. Confidentiality was maintained by removing personal identifiers and anonymizing the dataset prior to analysis. Results Socio-Demographic Characteristics 206 patients who had anastomotic surgery were included in this study. Male participants accounted for 70.1% (n = 146) of cases while females made up the remaining 29.9% (n = 60). About one-fourth of the participant's age was betwen 40–60. The majority of participants were male (Table 1 ). Table 1 Socio-demographic and behavioral characteristics among patients who had intestinal anastomosis surgery ZMH and YMH State referral Hospitals, from February 2017 to February 2020. (n = 206). Variable Category Frequency Percentage Age Group 0–20 25 12.14 20–40 48 23.3 40–60 61 29.61 60–80 57 27.67 > 80 15 7.28 Marital Status Single 49 23.79 Married 148 71.84 Divorced 9 4,37 Sex Male 146 70.9 Female 60 29.1 Rate of Comorbid Conditions Medical comorbidities were present among 22.8% (n = 47) of the patients. Among the comorbidities, hypertension (HTN) made up the commonest incidence, occurring in 68% (n = 32) of the patients followed by Diabetes Mellitus (DM) in 532% (n = 15) of patients. Previous history of abdominal surgery was elicited in 25.2% (n = 52) of patients. (Table 2 ) Table 2 Comorbidity among patients who had intestinal anastomosis surgery ZMH and YMH State referral Hospitals, from February 2017 to February 2020. (n = 206) Comorbidity Frequency Percentage Presence of comorbidity Yes 47 22.8 No 159 77.2 Hypertension 32 68 Diabetes Mellitus 15 32 Previous Surgery 52 25.2 Preoperative profile 11.7% (n = 24) of patients were anemic with hemoglobin (HgB) levels below 11 mg/dl. Most patients (95.2%) (n = 196) are ASA Class I and II. The proportion of patients in ASA class III and IV were found to be 3% (n = 6) and 2% (n = 4) respectively. 42.2% (n = 87) of the evaluated cases were operated without bowel preparation. All the emergency operations were performed without bowel preparation. From the elective operations, 21.2% of cases were operated without bowel preparation. 27.2% (n = 55) of the cases were operated on an emergency basis while the rest of 72.8% were operated on an elective basis (n = 155). (Table 3 ) Table 3 Pre-operative characteristics of patients who had intestinal anastomosis surgery ZMH and YMH State referral Hospitals, from February 2017 to February 2020. (n = 206) Variable Category Frequency Percentage Hemoglobin > 11 182 88.3 < 11 24 11.7 ASA Class I 111 53.9 II 85 41.3 III 6 2.9 IV 4 1.9 Bowel Preparation Yes 119 57.8 No 87 42.2 Type of Operation Elective 151 72.8 Emergency 55 27.2 Indication for the anastomosis surgery Anastomotic closure was most commonly done for redundant sigmoid colon in 30.6% (n = 63) of the cases, for colostomy closure in 13.6% (n = 28) for Common Bile Duct (CBD) stone in 11.2% (n = 23) and for colorectal cancers in 9.2% (n = 19). (Table 4 ) Table 4 Indication for intestinal anastomosis surgery ZMH and YMH State referral Hospitals, from February 2017 to February 2020. (n = 206) Primary Pathology Frequency Percentage Colostomy closure 28 13.6 Sigmoid volvulus 4 1.9 Redundant sigmoid 63 30.6 Colorectal cancer 19 9.2 Gastric cancer 7 3.4 Intussusceptions 9 4.4 Adhesion 11 5.3 Small bowel volvulus 5 2.4 Perforated viscus 9 4.4 Abdominal trauma 8 3.9 Hernia 8 3.9 CBD stone 23 11.2 CBD stricture 2 1 Others 10 4.9 Intraoperative profile The level of anastomosis was in the large bowel among 62.6% (n = 129) of the patients and in the small bowel in the remaining 37.4% (n = 77) of the patients. The most common site of CIA in the large bowel was colo-colic (60.5%) (n = 78), with the commonest sites in the small bowel being ileo-ileal (36.4%) (n = 28) and hepatico-jejunostomy (28.6%) (n = 22). On intraoperative assessment of bowel viability, 20.0% (n = 11) had gangrenous bowel segments. Prolonged anesthesia time (as defined by time under anesthesia beyond 04 hours) was noted among 14.1% of the operations. Intraoperative blood loss (as defined by loss above 500 ml) was noted in 16.5% (n = 34) of the operations. (Table 5 ) Table 5 The intraoperative status of patients who had intestinal anastomosis surgery ZMH and YMH State referral Hospitals, from February 2017 to February 2020. (n = 206) Characteristics Frequency Percentage Anastomosis Small Bowel 77 37.4 Jejunojejunal 12 15.6 Jejunoileal 5 6.5 Ileoileal 28 36.4 Choledochoduodenostomy 3 3.8 Hepaticojejunostomy 22 28.6 Gastrojejunostomy& Jejunojejunostomy 7 9.1 Large Bowel 129 62.6 Colocolic 78 60.5 Ileocolic 22 17.1 Colorectal 29 22.5 Bowel Viability Gangrenous 11 20 Viable 44 80 Anesthesia Time 4 hr. 29 14.1 Blood Loss 500ml 34 16.5 Rate of anastomotic leakage. Clinical anastomotic leak rate in this study is 8.3%. (Fig. 1 ) Post-operative profile The median postoperative hospital stay of the study population was seven days, with a minimum duration of five days and a maximum duration of 103 days. The majority of patients were (80.6%) (n = 164) discharged within 10 days, 11.7% (n = 18) stayed between 10–20 days, and the remaining 7.8% (n = 7) had stayed more than 20 days postoperatively (Table 6 ). A total of 14 patients died in the study sites making the mortality rate 6.8%. Table 6 ) the rate and post-operative hospital stay of patients who had intestinal anastomosis surgery ZMH and YMH State referral Hospitals, from February 2017 to February 2020. (n = 206) Characteristics Frequency Percentage Post-Operative stay 1–10 164 80.6 10–20 18 11.7 > 20 days 7 7.8 Died 14 6.8 Anastomotic leakage Yes 17 8.3 No 189 91.75 Clinical factors of anastomotic leakage Patient’s clinical outcome like postoperative hospital stay and treatment outcome were strongly associated to ATL. The odds of developing ATL were 5.5 times higher among patients stayed hospital for > 20 days when compared to those discharged < 10days (AOR; 95% CI: 1.99–7.12, P = 0.000). When compared to discharged patients, died patients 5.5 times more likely to develop ATL with (AOR 5.495; 95% CI: 1.517-20.00, P = 0.004) (Table 7 ). Table 7 Multivariate logistic regression of factors associated with clinical anastomosis leakage among patients who had intestinal anastomosis in MH and YMH, from February 2017 to February 2020 (n = 206). Variables Category Anastomotic Leak AOR: (95%CI) P-value Yes (n, %) No (n, %) Sex Male 13(8.9%) 133(91.1%) 4.23(0.98–2.98) 0.596 Female 4(6.7%) 56(93.3%) Ref. Ref. Comorbidity Yes 3(6.4%) 44(93.6%) 2.56(1.76–3.89) 0.596 No 14(8.8%) 145(91.2%) Ref. Ref. Hypertension Yes 2(6.2%) 30(93.8%) 7.45(3.76–11.34) 0.127 No 10(17.9%) 46(82.1%) Ref. Ref. Diabetes Yes 1(9.1%) 10(90%) 12.43(6.42–21.78) 0.639 No 11(14.3%) 66(85.7%) Ref. Ref. Previous Surgery Yes 8(15.4%) 44(4.6%) 7.69(3.75–15.93) 0.325 No 3(8.3%) 33(91.7%) Ref. Ref. Hemoglobin (mg/dL) > 11 13(7.1%) 169(92.9%) 0.89(0.49–2.76) 0.111 < 11 4(16.7%) 20(83.3%) Ref. Ref. ASA Class I 6(5.4%) 105(94.6%) 10.54(6.31–25.10) 0.204 II 10(11.8%) 75(88.2%) 14.77(3.02–19.22) 0.709 IV 1(25%) 3(75%) Ref. Ref. Bowel Preparation Yes 9(7.6%) 110(92.4%) 0.46(0.25–1.24) 0.674 No 8(9.2%) 79(90.8%) Ref. Ref. Type of Operation Elective 9(6%) 142(94%) 9.77(7.49–7.06) 0.054 Emergency 8(14.5%) 47(85.5%) Ref. Ref. Bowel Viability Gangrenous 6(54.5%) 5(45.5%) 4.88(1.62–14.69) 0.000 Viable 2(4.5%) 42(95.5%) Ref. Ref. Anastomosis Site Small Bowel 8(10.4%) 69(89.6%) 1.45(0.57–7.43) 0.389 Large Bowel 9(7%) 120(93%) Ref. Ref. Anastomosis Type (Small Bowel) Jejunojejunal 1(7.7%) 11(92.3%) 3.13(1.81–9.75) 0.124 Jejunoileal 0 5(100%) 1. 54(0.57–6.04) 0.365 Ileoileal 6(21.4%) 22(78.6%) 0.20(0.09–1.27) 0.567 Choledochoduodenostomy 0 3(100%) 0.45(0.16–1.51) 0.781 Hepaticojejunostomy 0 22(100%) 0.69(0.33–2.45) 0.243 Gastrojejunostomy & Jejunojejunostomy 1(14.3%) 6(85.7%) ` Ref. Ref. Anastomosis Type (Large Bowel) Colocolic 3(3.8%) 75(96.2%) 1.56(1.07–0.91) 0.182 Ileocolic 2(9.1%) 20(90.9%) 7.45(2.23–18.76) 0.775 Colorectal 4(13.8%) 25(86.2%) Ref. Ref. Anesthesia Time 4hr 4(13.8%) 25(86.2%) Ref. Ref. Blood Loss > 500ml 6(17.6%) 28(82.4%) 3.13; (1.07–9.17) 0.029 < 500ml 11(6.4%) 161(93.6%) Ref Ref. Post-Op Stay 20 days 9(52.9%) 7(3.7%) 5.49(1.99–7.12) 0.000 Outcome Discharged 13(76.5%) 179(94.7%) Ref. Ref. Died 4(23.5%) 10(5.3%) 5.49(1.51-20.00) 0.004 Clinical intestinal anastomosis leak Socio-demographic and pre-operative factors association with anastomotic leakage Both patient’s socio-demographic characteristics and pre-operative parameters were not statistically associated. We have observed the higher proportion of ATL among emergency operation compared to elective operation (14.5% vs 6%). Even though the association did not cross the range for statistical significance in an absolute sense (p = 0.054), it is very close to the cutoff point of 0.05 and can be considered a significant difference in a practical sense. The relative proportions and the values of their statistical significance for other variables are further described. (Table 7 ) Intraoperative Factors Association with Anastomotic Leakage In the analysis for the association of intraoperative parameters with the occurrence of ATL, the viability of the bowel and the amount of intraoperative blood loss were significantly associated with ATL. The relative proportion of ATL in those with gangrenous bowel was 54.5% compared to 4.5% in those with viable bowel (P 500ml were increased risk of AL (AOR 3.13; 95% CI: 1.07–9.17; p = 0.029) ((Table 7 ). Discussion This study evaluated the incidence, clinical outcomes, and associated risk factors for clinical anastomotic leakage (AL) among patients who underwent intestinal anastomosis in two major referral hospitals in Ethiopia. The overall leakage rate identified was 8.3%, which is slightly higher than the commonly reported range of 4.9–7.2% in the general population [5, 12, 50] , but in alignment with findings from other studies in resource-limited settings [31, 50]. AL remains a significant complication due to its association with increased morbidity, mortality, and prolonged hospitalization. Our findings are consistent with previous studies that have reported AL as a major contributor to postoperative complications and patient deterioration [ 4 , 5 ]. The observed 23.5% mortality rate among patients with ATL is also in line with other studies emphasizing the severity of this complication [ 12 , 14 , 15 ]. Risk factor analysis revealed several important associations. Notably, the presence of gangrenous bowel significantly increased the risk of leakage. This can be attributed to compromised tissue viability at the anastomotic site, which impairs healing and predisposes patients to dehiscence [ 12 , 40 ]. Similarly, intraoperative blood loss of more than 500 ml was found to be associated with AL. Although some studies have suggested that excessive blood loss compromises perfusion and tissue oxygenation, leading to poor healing [ 42 ], in our study this variable showed an inverse relationship with AL, potentially due to more cautious intraoperative management in patients with significant bleeding. Emergency surgeries had a higher rate of leakage compared to elective operations. While this association did not reach statistical significance (p = 0.054), it is clinically relevant. Emergency surgeries are often performed in suboptimal conditions, such as inadequate bowel preparation, hemodynamic instability, or delayed presentation, which may contribute to poor anastomotic healing [ 12 , 37 ]. This observation underscores the importance of optimizing preoperative conditions whenever possible. Bowel preparation emerged as another contributing factor. Most emergency surgeries were performed without mechanical preparation, and a higher rate of ATL was observed in these patients. Though the literature presents mixed views on the effectiveness of mechanical bowel cleansing, some evidence supports its role in reducing infection and leakage risks, particularly when combined with oral antibiotics [ 36 , 38 ]. While several comorbid conditions like hypertension and diabetes have been implicated in previous studies as risk factors for ATL [ 12 , 39 , 44 ], our study did not find a statistically significant correlation. This might be due to the relatively low number of patients with documented comorbidities or differences in documentation and follow-up. Our findings are consistent with studies that have emphasized the complexity of ATL and its multifactorial etiology [ 4 , 9 , 10 ]. Bowel viability, operative timing, and intraoperative blood loss are all modifiable risk factors that should be addressed through targeted perioperative planning and careful surgical technique. The study’s results highlight the need for improved preoperative assessment and intraoperative decision-making in high-risk patients. In particular, patients presenting with ischemic or gangrenous bowel segments should be carefully evaluated before primary anastomosis is attempted. In some cases, diversion may be a safer option to reduce the risk of leakage. Our analysis also demonstrated that AL significantly prolongs postoperative hospital stay and is associated with increased mortality, findings that emphasize the importance of early diagnosis and timely intervention. Monitoring for clinical signs such as fever, abdominal pain, and changes in vital signs remains crucial, especially in facilities with limited access to advanced imaging and laboratory diagnostics [ 16 , 17 ]. While this study provides valuable insights, its limitations should be acknowledged. It was conducted in two hospitals and based on retrospective chart reviews, which may introduce selection bias or underreporting. Additionally, diagnostic confirmation of AL relied primarily on clinical and intraoperative findings, which may differ from radiologically confirmed leakages used in other settings. In conclusion, clinical anastomotic leakage in intestinal surgery remains a substantial burden in Ethiopian hospitals. The findings suggest that bowel viability and blood loss are significant factors associated with AL. These insights can help guide risk stratification, improve patient outcomes, and inform future prospective studies that further explore optimal management strategies for high-risk surgical populations. Conclusion In this study Clinical anastomotic leakage was found higher than the expected rate. Bowel viability and Blood loss were associated with increased risk of clinical anastomotic leak. Additionally, presence of anastomotic leaks are associated with increased mortality and extended hospitalization. Abbreviations AL Anastomotic Leakage CAL Clinical Anastomotic Leakage ASA American Society of Anesthesiologists (Physical Status Classification System) CBD Common Bile Duct DM Diabetes Mellitus HTN Hypertension ZMH Zewditu Memorial Hospital YMH Yekatit 12 Hospital Declarations Acknowledgments The authors extend their sincere gratitude to the Department of Surgery at Addis Ababa University, as well as the staff of ZMH and YMH, and all the study participants for their invaluable technical assistance and guidance. Authors' Contributions YTM: Conceptualization, investigation, data collection, methodology, and writing the original draft. MAK : Conceptualization, investigation, data collection, methodology, and writing the original draft. SNG: Data collection, methodology, and writing the original draft. NSA : Data collection, methodology, and writing the original draft. BTG: Data collection, methodology, and writing the original draft. SSD : Data collection, methodology, and writing the original draft. HAA: Data collection, methodology, and writing the original draft. MMM : Data collection, methodology, and writing the original draft. TAA : Data collection, methodology, and writing the original draft. H BK : Data collection, methodology, and writing the original draft. Ethics approval and consent to participate The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki (6 the revision, 2008) and has been approved by the Institutional Review Board of the College of Health Sciences, Addis Ababa University. Health Sciences, Addis Ababa University. The board also approved the waived requirement for consent to participate since the study utilized secondary data. Consent to publication Not Applicable Competing Interests The author(s) have disclosed no potential conflicts of interest related to the conduct, writing, or publication of this article. 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Surgery for Obesity and Related Diseases [Internet]. 2015 Mar 1 [cited 2019 Nov 16];11(2):313–20. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4425611/ Hakkarainen TW, Steele SR, Bastaworous A, Dellinger EP, Farrokhi E, Farjah F, et al. Nonsteroidal Anti-inflammatory Drugs and the Risk for Anastomotic Failure. JAMA Surg. 2015;150(3):223. Krarup PM, Nordholm-Carstensen A, Jorgensen LN, Harling H. Anastomotic leak increases distant recurrence and long-term mortality after curative resection for colonic cancer: a nationwide cohort study. Annals of surgery [Internet]. 2014 May 1 [cited 2019 Nov 25];259(5):930–8. Available from: https://europepmc.org/article/med/24045445 Merkow RP, Bentrem DJ, Mulcahy MF, Chung JW, Abbott DE, Kmiecik TE et al. Effect of postoperative complications on adjuvant chemotherapy use for stage III colon cancer. Annals of Surgery [Internet]. 2013 Dec 1 [cited 2019 Oct 26];258(6):847–53. Available from: https://pubmed.ncbi.nlm.nih.gov/24169157/ Turrentine FE, Denlinger CE, Simpson VB, Garwood RA, Guerlain S, Agrawal A, et al. Morbidity, Mortality, Cost, and Survival Estimates of Gastrointestinal Anastomotic Leaks. J Am Coll Surg. 2015;220(2):195–206. Brisinda G, Vanella S, Cadeddu F, Civello IM, Brandara F, Nigro C, et al. End-to-end versus end-to-side stapled anastomosis after anterior resection for rectal cancer. J Surg Oncol. 2009;99(1):75–9. Pickleman J, Watson W, Cunningham J, Fisher SG, Gamelli R. The failed gastrointestinal anastomosis: an inevitable catastrophe? J Am Coll Surg. 1999;188(5):473–82. Sultan R, Chawla T, Zaidi M. Factors affecting anastomotic leak after colorectal anastomosis in patients without protective stoma in tertiary care hospital. JPMA The Journal of the Pakistan Medical Association [Internet]. 2014 Feb 1 [cited 2019 Oct 19];64(2):166–70. Available from: https://pubmed.ncbi.nlm.nih.gov/24640806/ Jung SH, Yu CS, Choi PW, Kim DD, Park IJ, Kim HC, et al. Risk Factors and Oncologic Impact of Anastomotic Leakage after Rectal Cancer Surgery. Dis Colon Rectum. 2008;51(6):902–8. Matthiessen P, Hallbook O, Andersson M, Rutegard J, Sjodahl R. Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis. 2004;6(6):462–9. Kirchhoff P, Dincler S, Buchmann P. A Multivariate Analysis of Potential Risk Factors for Intra- and Postoperative Complications in 1316 Elective Laparoscopic Colorectal Procedures. Ann Surg. 2008;248(2):259–65. Wille-Jorgensen P, Guenaga KF, Matos D, Castro AA. Pre-operative mechanical bowel cleansing or not? An updated meta-analysis. Colorectal Dis. 2005;7(4):304–10. Irvin TT, Goligher JC. Etiology of disruption of intestinal anastomoses. Br J Surg. 1973;60(6):461–4. Burke P, Mealy K, Gillen P, Joyce W, Traynor O, Hyland J. Requirement for bowel preparation in colorectal surgery. Br J Surg. 1994;81(6):907–10. Sultan R, Chawla T, Zaidi M. Factors affecting anastomotic leak after colorectal anastomosis in patients without protective stoma in tertiary care hospital. JPMA The Journal of the Pakistan Medical Association [Internet]. 2014;64(2):166–70. Available from: https://pubmed.ncbi.nlm.nih.gov/24640806/ Lipska MA, Bissett IP, Parry BR, Merrie AEH. Anastomotic leakage after lower gastrointestinal anastomosis: men are at a higher risk. ANZ journal of surgery [Internet]. 2006;76(7):579–85. Available from: https://pubmed.ncbi.nlm.nih.gov/16813622/ Kirchhoff P, Clavien PA, Hahnloser D. Complications in colorectal surgery: risk factors and preventive strategies. Patient Saf Surg. 2010;4(1):5. Chen HH, Wexner SD, Iroatulam A, Pikarsky AJ, Ömer A, Nogueras JJ, et al. Laparoscopic colectomy compares favorably with colectomy by laparotomy for the reduction of postoperative ileus. Dis Colon Rectum. 2000;43(1):61–5. Kiran RP, Delaney CP, Senagore AJ, Millward BL, Fazio VW. Operative blood loss and use of blood products after laparoscopic and conventional open colorectal operations. Archives of Surgery (Chicago, Ill: 1960) [Internet]. 2004;139(1):39–42. Available from: https://pubmed.ncbi.nlm.nih.gov/14718273/ Lin JK, Yueh TC, Chang SC, Lin CC, Lan YT, Wang HS, et al. The Influence of Fecal Diversion and Anastomotic Leakage on Survival after Resection of Rectal Cancer. J ofGastrointestinal Surg. 2011;15(12):2251–61. Eberl T, Jagoditsch M, Klingler A, Tschmelitsch J. Risk factors for anastomotic leakage after resection for rectal cancer. American Journal of Surgery [Internet]. 2008;196(4):592–8. Available from: https://pubmed.ncbi.nlm.nih.gov/18571620/ Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 21 Aug, 2025 Read the published version in BMC Gastroenterology → Version 1 posted Editorial decision: Revision requested 27 Jun, 2025 Reviews received at journal 17 Jun, 2025 Reviews received at journal 14 Jun, 2025 Reviewers agreed at journal 11 Jun, 2025 Reviewers agreed at journal 06 Jun, 2025 Reviewers agreed at journal 05 Jun, 2025 Reviewers invited by journal 28 May, 2025 Editor assigned by journal 20 May, 2025 Editor invited by journal 02 May, 2025 Submission checks completed at journal 30 Apr, 2025 First submitted to journal 30 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6547597","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":462999972,"identity":"6b29a513-d8fe-4d20-96d5-6b80a322b6a2","order_by":0,"name":"Yilkal Teshome Numaro","email":"","orcid":"","institution":"Gebre Tsadik Shawo General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yilkal","middleName":"Teshome","lastName":"Numaro","suffix":""},{"id":462999974,"identity":"312a7191-8805-4ee4-921a-434870dce4e6","order_by":1,"name":"Molla Asnake Kebede","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9klEQVRIiWNgGAWjYFAC5sYDYJqHgf33jwqQAHMDAS2MDTAtDNIMZ0BaGEnRwtgGEcGrQbe9seHAj5q6PP6ewweMC+fVRvO3A7X8qNiGU4vZmYMNB3uOHS6WONuWkDxz2/HcGYcZGxh7ztzGreVGYsMBHrYDiQ3neQwO8G47ltsA1MLM2IZfy8E//+oS55/n/9jAO+dY7nxitBzmbWNO3HC2h5mZt6EmdwNBLUC/HJbtO5y48cwxM8YZxw7kbgRqOYjXL8ebDz58860ucd6Z5GcMH2rqcuedP3zwwY8K3FrQwWEweYBo9UBQR4riUTAKRsEoGCEAAI0xaUMgoOzyAAAAAElFTkSuQmCC","orcid":"","institution":"Mizan-Tepi University","correspondingAuthor":true,"prefix":"","firstName":"Molla","middleName":"Asnake","lastName":"Kebede","suffix":""},{"id":462999976,"identity":"a5b69d45-4d9a-4392-8c69-86f685e60691","order_by":2,"name":"Shimelis Nigussie","email":"","orcid":"","institution":"Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Shimelis","middleName":"","lastName":"Nigussie","suffix":""},{"id":462999977,"identity":"75af1d7d-d54c-4c00-85c4-29b25035ceff","order_by":3,"name":"Nelbyou Seyoum Abebe","email":"","orcid":"","institution":"Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Nelbyou","middleName":"Seyoum","lastName":"Abebe","suffix":""},{"id":462999980,"identity":"fc9b4dbf-aaf8-4846-986c-b6419e6e2334","order_by":4,"name":"Bizuayehu Tassew Gossaye","email":"","orcid":"","institution":"Mizan-Tepi University","correspondingAuthor":false,"prefix":"","firstName":"Bizuayehu","middleName":"Tassew","lastName":"Gossaye","suffix":""},{"id":462999982,"identity":"ad8eb36d-7b58-4453-a4f9-90e13ca1ba5e","order_by":5,"name":"Sebsibe Dingeto Shega","email":"","orcid":"","institution":"Mizan-Tepi University","correspondingAuthor":false,"prefix":"","firstName":"Sebsibe","middleName":"Dingeto","lastName":"Shega","suffix":""},{"id":462999985,"identity":"1bbce7df-0b5d-4691-966d-1aa8e59c3c39","order_by":6,"name":"Hezron Adinew Addi","email":"","orcid":"","institution":"Mizan-Tepi University","correspondingAuthor":false,"prefix":"","firstName":"Hezron","middleName":"Adinew","lastName":"Addi","suffix":""},{"id":462999986,"identity":"f5a3b9ca-86a4-44ce-8329-8ff92d8f31d5","order_by":7,"name":"Melkamu Mitikie Melak","email":"","orcid":"","institution":"Mizan-Tepi University","correspondingAuthor":false,"prefix":"","firstName":"Melkamu","middleName":"Mitikie","lastName":"Melak","suffix":""},{"id":462999987,"identity":"5716a4f0-e1ea-4c87-8989-3d7901af1d6a","order_by":8,"name":"Turi Abateka Abadiga","email":"","orcid":"","institution":"Mizan-Tepi University Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Turi","middleName":"Abateka","lastName":"Abadiga","suffix":""},{"id":462999988,"identity":"ac79b813-975d-4bcd-8e66-284d5af97fce","order_by":9,"name":"Henok Birhanu Kassa","email":"","orcid":"","institution":"Mizan-Tepi University","correspondingAuthor":false,"prefix":"","firstName":"Henok","middleName":"Birhanu","lastName":"Kassa","suffix":""}],"badges":[],"createdAt":"2025-04-28 11:53:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6547597/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6547597/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12876-025-04191-5","type":"published","date":"2025-08-21T16:29:47+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":83682484,"identity":"7d9106b4-92ed-4479-b059-fdfa0b0cddd9","added_by":"auto","created_at":"2025-05-30 16:29:30","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":38994,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRate of clinical anastomosis leakage among patients who had intestinal anastomosis in MH and YMH, from February 2017 to February 2020 (n = 206).\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6547597/v1/f3f646a47d586666c9f9e132.png"},{"id":89847623,"identity":"87c5224d-1be7-49b0-ae24-b34e5513066a","added_by":"auto","created_at":"2025-08-25 16:43:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2030468,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6547597/v1/dc178ffd-d56e-4de5-991a-69f0c4cc570f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical anastomosis leakage and determinant factors among patients who had intestinal anastomosis in two Ethiopian tertiary hospitals","fulltext":[{"header":"Background","content":"\u003cp\u003eIntestinal anastomosis plays a vital role in restoring bowel continuity after resection and is frequently utilized in various surgical scenarios. Both elective and emergency procedures rely heavily on the integrity of the anastomosis for favorable outcomes. Pioneering surgical techniques, refined over time, have aimed to optimize healing and minimize complications such as leakage \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eNevertheless, Intestinal anastomotic leakage (AL) continues to be among the most serious and feared complications following gastrointestinal surgery. It is typically defined as a breakdown at the anastomotic site leading to leakage of intestinal contents into the abdominal cavity. This event is not only a major cause of surgical morbidity but also significantly contributes to mortality and resource utilization \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eMultiple factors contribute to the risk of AL, including impaired perfusion, infection, tension on the anastomosis, and systemic conditions such as anemia, malnutrition, and diabetes mellitus. Technical errors during surgery may further exacerbate the risk \u003csup\u003e[\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/sup\u003e The incidence of AL varies considerably by procedure type, with colorectal surgeries often having the highest risk for some estimates reporting up to 26% leakage rates \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/sup\u003e These leaks may range in presentation from fulminant peritonitis to insidious signs such as fever or delayed gastrointestinal function, typically surfacing around the fifth to seventh postoperative day \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eDelayed diagnosis is particularly problematic in settings with limited diagnostic resources, where subtle clinical changes may be overlooked. Furthermore, early discharge in cost-conscious systems may prevent timely recognition and intervention, increasing the likelihood of complications and readmissions \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe scarcity of context-specific data in Ethiopia has hindered progress in understanding and managing AL. This research aims to fill that gap by evaluating the frequency and associated clinical factors of AL in two major referral hospitals in Addis Ababa. The findings are expected to provide a foundational understanding for improving clinical decision-making, reducing postoperative complications, and guiding policy reforms aimed at enhancing surgical care quality.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Area\u003c/h2\u003e \u003cp\u003eThis study was conducted in two major referral hospitals located in Addis Ababa, Ethiopia: Zewditu Memorial Hospital (ZMH) and Yekatit 12 Hospital (YMH). These institutions were chosen due to their high surgical case volume and their critical role in serving a large population in both urban and peri-urban areas.\u003c/p\u003e \u003cp\u003eZMH, situated on Taitu Street, is a public hospital offering a range of medical services, including approximately 10 major surgical procedures per day. With more than 6,000 outpatient visits each month, it is a key facility for the city and its surroundings. YMH is a specialized tertiary care center that manages complex surgical cases and provides multidisciplinary care involving departments such as surgery, in5ternal medicine, and intensive care. It serves an estimated catchment population of over five million people.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Design, and Period\u003c/h3\u003e\n\u003cp\u003eA hospital-based retrospective cross-sectional study was conducted and data collection was undergone from March 2021to June 2021. The study reviewed patients who underwent intestinal anastomosis surgery between 2016 and 2019.\u003c/p\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003eAll patients who full filled the inclusion criteria during the study period at ZMH and YMH.\u003c/p\u003e \u003cp\u003e \u003cb\u003eInclusion and Exclusion criteria.\u003c/b\u003e \u003c/p\u003e\n\u003ch3\u003eInclusion criteria\u003c/h3\u003e\n\u003cp\u003ePatient in all age\u003c/p\u003e \u003cp\u003ePatients with confirmed diagnosis of clinical anastomosis leakage\u003c/p\u003e \u003cp\u003ePatients whose outcome is known\u003c/p\u003e\n\u003ch3\u003eExclusion criteria\u003c/h3\u003e\n\u003cp\u003eUnderwent primary closure of small bowel perforations without bowel resection,\u003c/p\u003e \u003cp\u003eReceived only stoma formation with proximal diversion without definitive resection, or\u003c/p\u003e \u003cp\u003eWere referred from other institutions already presenting with postoperative complications such as leakage, intra-abdominal abscesses, or enterocutaneous fistulas.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSample Size, Determination and Sampling Procedure\u003c/h2\u003e \u003cp\u003eUsing a lottery method, two hospitals were randomly selected from six high-volume facilities. Subsequently, convenient sampling was employed to recruit patients who met the inclusion criteria. A total of 224 patients were initially included. After excluding 18 cases due to incomplete or missing data, the final analysis comprised 206 patients.\u003c/p\u003e \u003cp\u003eNo formal sample size calculation was performed; instead, all eligible patients presenting during the study period were consecutively included to maximize the available sample size and ensure adequate representation.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eVariables\u003c/h3\u003e\n\u003cp\u003eThe dependent variable was clinical anastomotic leakage (AL), defined as a leak diagnosed by a physician and confirmed by documentation of re-laparotomy or discharge records.\u003c/p\u003e\n\u003ch3\u003eIndependent variables included:\u003c/h3\u003e\n\u003cp\u003e \u003cstrong\u003eSocio-demographic\u003c/strong\u003e \u003cp\u003eAge, sex, marital status, alcohol and smoking history\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePre-operative\u003c/strong\u003e \u003cp\u003eComorbidities, ASA classification, diagnosis, hematocrit, and creatinine levels\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eIntra-operative\u003c/strong\u003e \u003cp\u003eType and duration of surgery, blood transfusions, surgical technique, anastomosis location and number, drain usage\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePost-operative\u003c/strong\u003e \u003cp\u003eComplications, hematocrit, sodium, potassium, and creatinine levels\u003c/p\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eOperational Definitions\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eClinical anastomosis leakage\u003c/strong\u003e \u003cp\u003eLeakage identified by the attending physician with supporting documentation of reoperation or discharge notes [3].\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLow ATL rate\u003c/strong\u003e \u003cp\u003eLeakage rate under 4.9% [7]\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHigh ATL rate\u003c/strong\u003e \u003cp\u003eLeakage rate over 7.2% [7]\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eData Collection Tool and Quality Control\u003c/h2\u003e \u003cp\u003eData were collected using a structured checklist developed after reviewing relevant literature and sample patient charts. The checklist was pretested on 5% of the intended sample size to identify and correct ambiguities. Feedback led to refinements in the tool. Six trained data collectors and three supervisors participated, following a one-day training workshop. The principal investigator conducted regular supervision and data quality audits.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eData Processing and Analysis\u003c/h2\u003e \u003cp\u003eData were entered and cleaned using EpiData version 4.6 and then exported to SPSS version 25 for analysis. Descriptive statistics were generated for key variables first. To asses\u0026rsquo; determinant factors for AL, all independent variables were analyzed using bivariate analysis, and variables with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.2 were entered into multivariate logistic regression. Statistical significance was determined at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Model fitness was assessed using the Hosmer-Lemeshow test, where p value of \u0026gt;\u0026thinsp;0.05 indicates data fitness. Results were reported using odds ratios with 95% confidence intervals.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eEthical Considerations\u003c/h2\u003e \u003cp\u003e Ethical clearance was obtained from the Ethical Review Committee of the College of Health Sciences at Addis Ababa University. Institutional permissions were secured from hospital authorities. As the study used secondary data, patient consent was waived. Confidentiality was maintained by removing personal identifiers and anonymizing the dataset prior to analysis.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n\u003ch2\u003eSocio-Demographic Characteristics\u003c/h2\u003e\n\u003cp\u003e206 patients who had anastomotic surgery were included in this study. Male participants accounted for 70.1% (n\u0026thinsp;=\u0026thinsp;146) of cases while females made up the remaining 29.9% (n\u0026thinsp;=\u0026thinsp;60). About one-fourth of the participant's age was betwen 40\u0026ndash;60. The majority of participants were male (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). \u0026nbsp;\u003c/p\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eSocio-demographic and behavioral characteristics among patients who had intestinal anastomosis surgery ZMH and YMH State referral Hospitals, from February 2017 to February 2020. (n\u0026thinsp;=\u0026thinsp;206).\u003c/span\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCategory\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eFrequency\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePercentage\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"5\" align=\"left\"\u003e\n\u003cp\u003eAge Group\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e0\u0026ndash;20\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e25\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e12.14\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e20\u0026ndash;40\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e48\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e23.3\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e40\u0026ndash;60\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e\u003cstrong\u003e61\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e29.61\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e60\u0026ndash;80\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e\u003cstrong\u003e57\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e27.67\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026gt;\u0026thinsp;80\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e\u003cstrong\u003e15\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e7.28\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSingle\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e\u003cstrong\u003e49\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e23.79\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMarried\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e\u003cstrong\u003e148\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e71.84\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDivorced\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e4,37\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e\u003cstrong\u003e146\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e70.9\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\"\u003e\n\u003cp\u003e\u003cstrong\u003e60\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e29.1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n\u003ch2\u003eRate of Comorbid Conditions\u003c/h2\u003e\n\u003cp\u003eMedical comorbidities were present among 22.8% (n\u0026thinsp;=\u0026thinsp;47) of the patients. Among the comorbidities, hypertension (HTN) made up the commonest incidence, occurring in 68% (n\u0026thinsp;=\u0026thinsp;32) of the patients followed by Diabetes Mellitus (DM) in 532% (n\u0026thinsp;=\u0026thinsp;15) of patients. Previous history of abdominal surgery was elicited in 25.2% (n\u0026thinsp;=\u0026thinsp;52) of patients. (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eComorbidity among patients who had intestinal anastomosis surgery ZMH and YMH State referral Hospitals, from February 2017 to February 2020. (n\u0026thinsp;=\u0026thinsp;206)\u003c/span\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\u003ccolgroup\u003e\u003c/colgroup\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eComorbidity\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eFrequency\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePercentage\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003ePresence of comorbidity\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e47\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e22.8\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e159\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e77.2\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eHypertension\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e32\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e68\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDiabetes Mellitus\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e15\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e32\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePrevious Surgery\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e52\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e25.2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n\u003ch2\u003ePreoperative profile\u003c/h2\u003e\n\u003cp\u003e11.7% (n\u0026thinsp;=\u0026thinsp;24) of patients were anemic with hemoglobin (HgB) levels below 11 mg/dl. Most patients (95.2%) (n\u0026thinsp;=\u0026thinsp;196) are ASA Class I and II. The proportion of patients in ASA class III and IV were found to be 3% (n\u0026thinsp;=\u0026thinsp;6) and 2% (n\u0026thinsp;=\u0026thinsp;4) respectively. 42.2% (n\u0026thinsp;=\u0026thinsp;87) of the evaluated cases were operated without bowel preparation. All the emergency operations were performed without bowel preparation. From the elective operations, 21.2% of cases were operated without bowel preparation. 27.2% (n\u0026thinsp;=\u0026thinsp;55) of the cases were operated on an emergency basis while the rest of 72.8% were operated on an elective basis (n\u0026thinsp;=\u0026thinsp;155). (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003ePre-operative characteristics of patients who had intestinal anastomosis surgery ZMH and YMH State referral Hospitals, from February 2017 to February 2020. (n\u0026thinsp;=\u0026thinsp;206)\u003c/span\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\u003ccolgroup\u003e\u003c/colgroup\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCategory\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eFrequency\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePercentage\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eHemoglobin\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u0026gt;\u0026thinsp;11\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e182\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e88.3\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;11\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e24\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e11.7\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eASA Class\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eI\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e111\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e53.9\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eII\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e85\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e41.3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eIII\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e2.9\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eIV\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e1.9\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eBowel Preparation\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e119\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e57.8\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e87\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e42.2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eType of Operation\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eElective\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e151\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e72.8\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eEmergency\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e55\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e27.2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n\u003ch2\u003eIndication for the anastomosis surgery\u003c/h2\u003e\n\u003cp\u003eAnastomotic closure was most commonly done for redundant sigmoid colon in 30.6% (n\u0026thinsp;=\u0026thinsp;63) of the cases, for colostomy closure in 13.6% (n\u0026thinsp;=\u0026thinsp;28) for Common Bile Duct (CBD) stone in 11.2% (n\u0026thinsp;=\u0026thinsp;23) and for colorectal cancers in 9.2% (n\u0026thinsp;=\u0026thinsp;19). (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003e\u003cspan class=\"BoldUnderline\"\u003eIndication for intestinal anastomosis surgery ZMH and YMH State referral Hospitals, from February 2017 to February 2020. (n\u0026thinsp;=\u0026thinsp;206)\u003c/span\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\u003ccolgroup\u003e\u003c/colgroup\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePrimary Pathology\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eFrequency\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePercentage\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eColostomy closure\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e13.6\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSigmoid volvulus\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e1.9\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eRedundant sigmoid\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e63\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e30.6\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eColorectal cancer\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e19\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e9.2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eGastric cancer\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e3.4\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eIntussusceptions\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e4.4\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAdhesion\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e11\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e5.3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSmall bowel volvulus\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e2.4\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePerforated viscus\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e4.4\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAbdominal trauma\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e8\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e3.9\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eHernia\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e8\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e3.9\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eCBD stone\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e23\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e11.2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eCBD stricture\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eOthers\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e10\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e4.9\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\n\u003ch2\u003eIntraoperative profile\u003c/h2\u003e\n\u003cp\u003eThe level of anastomosis was in the large bowel among 62.6% (n\u0026thinsp;=\u0026thinsp;129) of the patients and in the small bowel in the remaining 37.4% (n\u0026thinsp;=\u0026thinsp;77) of the patients. The most common site of CIA in the large bowel was colo-colic (60.5%) (n\u0026thinsp;=\u0026thinsp;78), with the commonest sites in the small bowel being ileo-ileal (36.4%) (n\u0026thinsp;=\u0026thinsp;28) and hepatico-jejunostomy (28.6%) (n\u0026thinsp;=\u0026thinsp;22). On intraoperative assessment of bowel viability, 20.0% (n\u0026thinsp;=\u0026thinsp;11) had gangrenous bowel segments. Prolonged anesthesia time (as defined by time under anesthesia beyond 04 hours) was noted among 14.1% of the operations. Intraoperative blood loss (as defined by loss above 500 ml) was noted in 16.5% (n\u0026thinsp;=\u0026thinsp;34) of the operations. (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable id=\"Tab5\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003eThe intraoperative status of patients who had intestinal anastomosis surgery ZMH and YMH State referral Hospitals, from February 2017 to February 2020. (n\u0026thinsp;=\u0026thinsp;206)\u003c/span\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\u003ccolgroup\u003e\u003c/colgroup\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eCharacteristics\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eFrequency\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePercentage\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"11\" align=\"left\"\u003e\n\u003cp\u003eAnastomosis\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSmall Bowel\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e77\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e37.4\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eJejunojejunal\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e15.6\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eJejunoileal\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e6.5\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eIleoileal\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e28\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e36.4\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eCholedochoduodenostomy\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e3.8\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eHepaticojejunostomy\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e22\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e28.6\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eGastrojejunostomy\u0026amp; Jejunojejunostomy\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e9.1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eLarge Bowel\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e129\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e62.6\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eColocolic\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e78\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e60.5\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eIleocolic\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e22\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e17.1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eColorectal\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e29\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e22.5\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eBowel Viability\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eGangrenous\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e11\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e20\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eViable\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e44\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e80\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAnesthesia Time\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;4 hr.\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e177\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e85.9\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026gt;\u0026thinsp;4 hr.\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e29\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e14.1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eBlood Loss\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;500ml\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e172\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e83.5\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026gt;\u0026thinsp;500ml\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e34\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e16.5\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eRate of anastomotic leakage.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClinical anastomotic leak rate in this study is 8.3%. (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\n\u003ch2\u003ePost-operative profile\u003c/h2\u003e\n\u003cp\u003eThe median postoperative hospital stay of the study population was seven days, with a minimum duration of five days and a maximum duration of 103 days. The majority of patients were (80.6%) (n\u0026thinsp;=\u0026thinsp;164) discharged within 10 days, 11.7% (n\u0026thinsp;=\u0026thinsp;18) stayed between 10\u0026ndash;20 days, and the remaining 7.8% (n\u0026thinsp;=\u0026thinsp;7) had stayed more than 20 days postoperatively (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e). A total of 14 patients died in the study sites making the mortality rate 6.8%.\u003c/p\u003e\n\u003ctable id=\"Tab6\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003e) \u003cspan class=\"Underline\"\u003ethe rate and post-operative hospital stay of patients who had intestinal anastomosis surgery ZMH and YMH State referral Hospitals, from February 2017 to February 2020. (n\u0026thinsp;=\u0026thinsp;206)\u003c/span\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\u003ccolgroup\u003e\u003c/colgroup\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eCharacteristics\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eFrequency\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePercentage\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003ePost-Operative stay\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e1\u0026ndash;10\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e164\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e80.6\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e10\u0026ndash;20\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e11.7\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026gt;\u0026thinsp;20 days\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e7.8\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDied\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e14\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e6.8\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAnastomotic leakage\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e17\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e8.3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e189\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e91.75\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\n\u003ch2\u003eClinical factors of anastomotic leakage\u003c/h2\u003e\n\u003cp\u003ePatient\u0026rsquo;s clinical outcome like postoperative hospital stay and treatment outcome were strongly associated to ATL. The odds of developing ATL were 5.5 times higher among patients stayed hospital for \u0026gt;\u0026thinsp;20 days when compared to those discharged\u0026thinsp;\u0026lt;\u0026thinsp;10days (AOR; 95% CI: 1.99\u0026ndash;7.12, P\u0026thinsp;=\u0026thinsp;0.000). When compared to discharged patients, died patients 5.5 times more likely to develop ATL with (AOR 5.495; 95% CI: 1.517-20.00, P\u0026thinsp;=\u0026thinsp;0.004) (Table\u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab7\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eMultivariate logistic regression of factors associated with clinical anastomosis leakage among patients who had intestinal anastomosis in MH and YMH, from February 2017 to February 2020 (n\u0026thinsp;=\u0026thinsp;206).\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\u003ccolgroup\u003e\u003c/colgroup\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eCategory\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eAnastomotic Leak\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eAOR: (95%CI)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eP-value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eYes (n, %)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNo (n, %)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eSex\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13(8.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e133(91.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.23(0.98\u0026ndash;2.98)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.596\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4(6.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e56(93.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eComorbidity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3(6.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44(93.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.56(1.76\u0026ndash;3.89)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.596\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14(8.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e145(91.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eHypertension\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2(6.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30(93.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.45(3.76\u0026ndash;11.34)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.127\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10(17.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e46(82.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eDiabetes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1(9.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10(90%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12.43(6.42\u0026ndash;21.78)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.639\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11(14.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e66(85.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003ePrevious Surgery\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8(15.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44(4.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.69(3.75\u0026ndash;15.93)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.325\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3(8.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33(91.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eHemoglobin (mg/dL)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;\u0026thinsp;11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13(7.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e169(92.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.89(0.49\u0026ndash;2.76)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.111\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4(16.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20(83.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eASA Class\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6(5.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e105(94.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10.54(6.31\u0026ndash;25.10)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.204\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eII\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10(11.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e75(88.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14.77(3.02\u0026ndash;19.22)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.709\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIV\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1(25%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3(75%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eBowel Preparation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9(7.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e110(92.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.46(0.25\u0026ndash;1.24)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.674\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8(9.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e79(90.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eType of Operation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eElective\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9(6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e142(94%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9.77(7.49\u0026ndash;7.06)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.054\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEmergency\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8(14.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e47(85.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eBowel Viability\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGangrenous\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6(54.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5(45.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.88(1.62\u0026ndash;14.69)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eViable\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2(4.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42(95.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eAnastomosis Site\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSmall Bowel\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8(10.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e69(89.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.45(0.57\u0026ndash;7.43)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.389\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLarge Bowel\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9(7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e120(93%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"6\" align=\"left\"\u003e\n\u003cp\u003eAnastomosis Type (Small Bowel)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eJejunojejunal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1(7.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11(92.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.13(1.81\u0026ndash;9.75)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.124\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eJejunoileal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5(100%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1. 54(0.57\u0026ndash;6.04)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.365\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIleoileal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6(21.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22(78.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.20(0.09\u0026ndash;1.27)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.567\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCholedochoduodenostomy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3(100%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.45(0.16\u0026ndash;1.51)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.781\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHepaticojejunostomy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22(100%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.69(0.33\u0026ndash;2.45)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.243\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGastrojejunostomy \u0026amp; Jejunojejunostomy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1(14.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6(85.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e` Ref.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eAnastomosis Type (Large Bowel)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eColocolic\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3(3.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e75(96.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.56(1.07\u0026ndash;0.91)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.182\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIleocolic\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2(9.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20(90.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.45(2.23\u0026ndash;18.76)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.775\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eColorectal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4(13.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25(86.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eAnesthesia Time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;4hr\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13(7.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e164(92.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7.35(3.14\u0026ndash;10.32)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.242\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;\u0026thinsp;4hr\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4(13.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25(86.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eBlood Loss\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;\u0026thinsp;500ml\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6(17.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28(82.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.13; (1.07\u0026ndash;9.17)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.029\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;500ml\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11(6.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e161(93.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003ePost-Op Stay\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;10 days\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2(11.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e164(86.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u0026ndash;20 days\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6(35.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18(9.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.37(0.61\u0026ndash;3.93)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.678\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;\u0026thinsp;20 days\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9(52.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7(3.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.49(1.99\u0026ndash;7.12)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eOutcome\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDischarged\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13(76.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e179(94.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDied\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4(23.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10(5.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.49(1.51-20.00)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003eClinical intestinal anastomosis leak\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\n\u003ch2\u003eSocio-demographic and pre-operative factors association with anastomotic leakage\u003c/h2\u003e\n\u003cp\u003eBoth patient\u0026rsquo;s socio-demographic characteristics and pre-operative parameters were not statistically associated. We have observed the higher proportion of ATL among emergency operation compared to elective operation (14.5% vs 6%). Even though the association did not cross the range for statistical significance in an absolute sense (p\u0026thinsp;=\u0026thinsp;0.054), it is very close to the cutoff point of 0.05 and can be considered a significant difference in a practical sense. The relative proportions and the values of their statistical significance for other variables are further described. (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\n\u003ch2\u003eIntraoperative Factors Association with Anastomotic Leakage\u003c/h2\u003e\n\u003cp\u003eIn the analysis for the association of intraoperative parameters with the occurrence of ATL, the viability of the bowel and the amount of intraoperative blood loss were significantly associated with ATL. The relative proportion of ATL in those with gangrenous bowel was 54.5% compared to 4.5% in those with viable bowel (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001, AOR\u0026thinsp;=\u0026thinsp;4.88, 95% CI\u0026thinsp;=\u0026thinsp;1.62\u0026ndash;14.69). This indicates that the presence of bowel gangrene increases the risk of ATL by 4.9 times. Blood loss of \u0026gt;\u0026thinsp;500ml were increased risk of AL (AOR 3.13; 95% CI: 1.07\u0026ndash;9.17; p\u0026thinsp;=\u0026thinsp;0.029) ((Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study evaluated the incidence, clinical outcomes, and associated risk factors for clinical anastomotic leakage (AL) among patients who underwent intestinal anastomosis in two major referral hospitals in Ethiopia. The overall leakage rate identified was 8.3%, which is slightly higher than the commonly reported range of 4.9\u0026ndash;7.2% in the general population \u003csup\u003e\u003cb\u003e[5, 12, 50]\u003c/b\u003e,\u003c/sup\u003e but in alignment with findings from other studies in resource-limited settings \u003csup\u003e\u003cb\u003e[31, 50].\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAL remains a significant complication due to its association with increased morbidity, mortality, and prolonged hospitalization. Our findings are consistent with previous studies that have reported AL as a major contributor to postoperative complications and patient deterioration \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/sup\u003e The observed 23.5% mortality rate among patients with ATL is also in line with other studies emphasizing the severity of this complication \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eRisk factor analysis revealed several important associations. Notably, the presence of gangrenous bowel significantly increased the risk of leakage. This can be attributed to compromised tissue viability at the anastomotic site, which impairs healing and predisposes patients to dehiscence \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/sup\u003e Similarly, intraoperative blood loss of more than 500 ml was found to be associated with AL. Although some studies have suggested that excessive blood loss compromises perfusion and tissue oxygenation, leading to poor healing \u003csup\u003e[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e],\u003c/sup\u003e in our study this variable showed an inverse relationship with AL, potentially due to more cautious intraoperative management in patients with significant bleeding.\u003c/p\u003e \u003cp\u003eEmergency surgeries had a higher rate of leakage compared to elective operations. While this association did not reach statistical significance (p\u0026thinsp;=\u0026thinsp;0.054), it is clinically relevant. Emergency surgeries are often performed in suboptimal conditions, such as inadequate bowel preparation, hemodynamic instability, or delayed presentation, which may contribute to poor anastomotic healing \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/sup\u003e This observation underscores the importance of optimizing preoperative conditions whenever possible.\u003c/p\u003e \u003cp\u003eBowel preparation emerged as another contributing factor. Most emergency surgeries were performed without mechanical preparation, and a higher rate of ATL was observed in these patients. Though the literature presents mixed views on the effectiveness of mechanical bowel cleansing, some evidence supports its role in reducing infection and leakage risks, particularly when combined with oral antibiotics \u003csup\u003e[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWhile several comorbid conditions like hypertension and diabetes have been implicated in previous studies as risk factors for ATL \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e],\u003c/sup\u003e our study did not find a statistically significant correlation. This might be due to the relatively low number of patients with documented comorbidities or differences in documentation and follow-up.\u003c/p\u003e \u003cp\u003eOur findings are consistent with studies that have emphasized the complexity of ATL and its multifactorial etiology \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/sup\u003e Bowel viability, operative timing, and intraoperative blood loss are all modifiable risk factors that should be addressed through targeted perioperative planning and careful surgical technique.\u003c/p\u003e \u003cp\u003eThe study\u0026rsquo;s results highlight the need for improved preoperative assessment and intraoperative decision-making in high-risk patients. In particular, patients presenting with ischemic or gangrenous bowel segments should be carefully evaluated before primary anastomosis is attempted. In some cases, diversion may be a safer option to reduce the risk of leakage.\u003c/p\u003e \u003cp\u003eOur analysis also demonstrated that AL significantly prolongs postoperative hospital stay and is associated with increased mortality, findings that emphasize the importance of early diagnosis and timely intervention. Monitoring for clinical signs such as fever, abdominal pain, and changes in vital signs remains crucial, especially in facilities with limited access to advanced imaging and laboratory diagnostics \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWhile this study provides valuable insights, its limitations should be acknowledged. It was conducted in two hospitals and based on retrospective chart reviews, which may introduce selection bias or underreporting. Additionally, diagnostic confirmation of AL relied primarily on clinical and intraoperative findings, which may differ from radiologically confirmed leakages used in other settings.\u003c/p\u003e \u003cp\u003eIn conclusion, clinical anastomotic leakage in intestinal surgery remains a substantial burden in Ethiopian hospitals. The findings suggest that bowel viability and blood loss are significant factors associated with AL. These insights can help guide risk stratification, improve patient outcomes, and inform future prospective studies that further explore optimal management strategies for high-risk surgical populations.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this study Clinical anastomotic leakage was found higher than the expected rate. Bowel viability and Blood loss were associated with increased risk of clinical anastomotic leak. Additionally, presence of anastomotic leaks are associated with increased mortality and extended hospitalization.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eAL\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAnastomotic Leakage\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCAL\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eClinical Anastomotic Leakage\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eASA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAmerican Society of Anesthesiologists (Physical Status Classification System)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCBD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCommon Bile Duct\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eDM\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDiabetes Mellitus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eHTN\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eZMH\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eZewditu Memorial Hospital\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eYMH\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eYekatit 12 Hospital\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors extend their sincere gratitude to the Department of Surgery at Addis Ababa University, as well as the staff of ZMH and YMH, and all the study participants for their invaluable technical assistance and guidance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eYTM:\u003c/strong\u003e Conceptualization, investigation, data collection, methodology, and writing the original draft.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMAK\u003c/strong\u003e: Conceptualization, investigation, data collection, methodology, and writing the original draft.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSNG:\u003c/strong\u003e Data collection, methodology, and writing the original draft.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNSA\u003c/strong\u003e: Data collection, methodology, and writing the original draft.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBTG:\u003c/strong\u003e Data collection, methodology, and writing the original draft.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSSD\u003c/strong\u003e: Data collection, methodology, and writing the original draft.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHAA:\u003c/strong\u003e Data collection, methodology, and writing the original draft.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMMM\u003c/strong\u003e: Data collection, methodology, and writing the original draft.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTAA\u003c/strong\u003e: Data collection, methodology, and writing the original draft.\u003c/p\u003e\n\u003cp\u003eH\u003cstrong\u003eBK\u003c/strong\u003e: Data collection, methodology, and writing the original draft.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki (6 the revision, 2008) and has been approved by the Institutional Review Board of the College of Health Sciences, Addis Ababa University. Health Sciences, Addis Ababa University. The board also approved the waived requirement for consent to participate since the study utilized secondary data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) have disclosed no potential conflicts of interest related to the conduct, writing, or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research was funded by Addis Ababa University. The funding doesn’t include publication fee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003ch3\u003eData Availability\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDietz UA, Debus ES. Intestinal anastomosis prior to 1882; a legacy of ingenuity, persistence, and research formed a foundation for modern gastrointestinal surgery. World Journal of Surgery [Internet]. 2005 Mar 1 [cited 2019 Oct 16];29(3):396\u0026ndash;401. 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J ofGastrointestinal Surg. 2011;15(12):2251\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEberl T, Jagoditsch M, Klingler A, Tschmelitsch J. Risk factors for anastomotic leakage after resection for rectal cancer. American Journal of Surgery [Internet]. 2008;196(4):592\u0026ndash;8. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/18571620/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/18571620/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Anastomotic leak, risk factors, predictors, or surgical complications","lastPublishedDoi":"10.21203/rs.3.rs-6547597/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6547597/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e: Intestinal anastomosis is a common surgical procedure, but anastomotic leaks remain significant postoperative complications, causing morbidity, prolonged hospital stays, and readmissions. This study aimed to identify the rate, determinant factors, and outcomes associated with anastomotic leakage for patients undergo gastrointestinal anastomoses in two major hospitals in Addis Ababa, Ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod:\u003c/strong\u003e A retrospective cross-sectional study used and 206 patients who underwent bowel anastomosis between 2016 and 2019 GC. To asses Determinant factor first bivariate analysis was done for all independent variables and for variables with P. value \u0026lt; 0.2 multiple logistic regresion was performed to identify independent predictors of anastomotic leakage. Odds ratios were computed, and a p-value \u0026lt;0.05 was considered statistically significant and Hosmer-Lemeshow goodness-of-fit test was run to ascertain the fitness of the model\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The clinical anastomotic leak (AL) rate in this study was 8.3%. The presence of gangrenous bowel at the time of surgery was a strong independent predictor of AL (AOR 4.88; 95% CI: 1.62–14.69; p \u0026lt; 0.001). Intraoperative blood loss greater than 500 mL was also significantly associated with an increased risk of leakage (AOR 3.13; 95% CI: 1.07–9.17; p = 0.029). Moreover, patients who developed anastomotic leakage had a higher risk of mortality (AOR 5.495; 95% CI: 1.517–20.00; p = 0.004). The presence of AL was additionally associated with prolonged hospital stay beyond 20 days (AOR 5.49; 95% CI: 1.99–7.12; p = 0.000). 3.13; (1.07–9.17)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e In this study, anastomotic leakage was found to be higher than expected. Bowel viability and the amount of blood loss were significant predictors of clinical anastomotic leakage. Additionally, the presence of anastomotic leakage was associated with increased mortality and prolonged hospitalization.\u003c/p\u003e","manuscriptTitle":"Clinical anastomosis leakage and determinant factors among patients who had intestinal anastomosis in two Ethiopian tertiary hospitals","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-30 16:21:26","doi":"10.21203/rs.3.rs-6547597/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-27T11:04:47+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-18T00:35:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-14T21:02:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"213958809316435957700189724915909639093","date":"2025-06-11T20:43:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"50706845757335045976911946721696046212","date":"2025-06-06T08:37:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"235980668613277321397759715493840678151","date":"2025-06-05T13:38:43+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-28T07:28:36+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-21T01:57:31+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-02T05:02:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-30T12:49:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Gastroenterology","date":"2025-04-30T12:47:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"67098985-bb8b-4062-a040-6d08227c0605","owner":[],"postedDate":"May 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-08-25T16:38:29+00:00","versionOfRecord":{"articleIdentity":"rs-6547597","link":"https://doi.org/10.1186/s12876-025-04191-5","journal":{"identity":"bmc-gastroenterology","isVorOnly":false,"title":"BMC Gastroenterology"},"publishedOn":"2025-08-21 16:29:47","publishedOnDateReadable":"August 21st, 2025"},"versionCreatedAt":"2025-05-30 16:21:26","video":"","vorDoi":"10.1186/s12876-025-04191-5","vorDoiUrl":"https://doi.org/10.1186/s12876-025-04191-5","workflowStages":[]},"version":"v1","identity":"rs-6547597","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6547597","identity":"rs-6547597","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}