Factors Associated With Anastomotic Bleeding After Laparoscopic Anterior Resection Of Rectum And Prevention Strategy

AIM: To investigate the risk factors causing anastomotic bleeding after laparoscopic anterior resection of rectum and then develop the prevention strategy.METHODS: Retrospectively analyze the clinical data of whom had laparoscopic anterior resection of rectum from January 2011 to December 2018 in Gastroenterological Surgery Department of Ruijin Hospital affiliated to Shanghai JiaoTong University School of Medicine,using univariate and multivariate analysis to explore the risk factors of postoperative anastomotic bleeding.The effect of prevention strategy was analyzed in a retrospective cohort study.RESULTS: Among 335 patients who had laparoscopic anterior resection of rectum without prevention strategy,the mean age of all patients was 63.6 ± 11.89years(range 26-91 years).There were 230 males(68.66%)and 105 females(31.34%).The incidence rate of anastomotic bleeding after laparoscopic anterior resection of rectal cancer was 5.37%(18/335).On univariate analysis,the occurrence of anastomotic bleeding after laparoscopic anterior resection of rectum was associated with anastomosis distance from anal verge(P < 0.05).The others had no obvious relationship with anastomotic bleeding.On multivariate analysis,anastomosis distance from anal verge ? 5cm(P = 0.020,OR = 5.983,95%CI: 1.331-26.885)was an independent risk factor of anastomotic bleeding.The incidence of anastomotic leakage was significantly increased in the anastomotic bleeding group(P<0.001).The results of retrospective cohort study showed that the intraoperative staple line reinforcement was a protective factor for postoperative anastomotic bleeding(P=0.012).CONCLUSION: Low anastomosis is an independent risk factor of anastomotic bleeding after laparoscopic anterior resection of rectum.Anastomotic bleeding may increase the incidence of anastomotic leakage.Intraoperative intervention can effectively reduce the incidence of postoperative anastomotic bleeding.Among them,staple line reinforcement is a better prevention strategy.