• Jennifer Leahy, David Schoetz, Peter Marcello, Thomas Read, Jason Hall, Patricia Roberts, and Rocco Ricciardi.
• Department of Colon and Rectal Surgery, Lahey Hospital & Medical Center, Tufts University Medical School, 41 Mall Road, Burlington, MA, 01805, USA.
• J. Gastrointest. Surg. 2014 Oct 1;18(10):1812-6.

ObjectiveThe objective of this study was to identify clinical leak in diverted colorectal anastomoses.DesignCohort analysis.SettingThe study was conducted in a subspecialty practice at a tertiary care facility.PatientsConsecutive subjects undergoing colorectal anastomosis and proximal fecal diversion between July 16, 2007 and June, 31 2012.InterventionsNo intervention was applied.Main Outcome MeasuresClinical anastomotic leak.ResultsTwo hundred forty-five patients underwent a colorectal anastomosis with proximal fecal diversion. A total of 34 (14%) clinical leaks were identified at a median of 43 days. Clinical leaks were identified in 13 (5%) patients within 30 days of surgery (early leaks) and in 21 (9%) patients after 30 days of surgery (late leaks). Age, sex, use of neoadjuvant chemoradiotherapy, and method of anastomotic construction were similar in patients with clinical leaks as compared to those with no evidence of leak. However, clinical leaks were more likely to develop in patients with a diagnosis of inflammatory bowel disease or other diagnoses, i.e., radiation enteritis, ischemia, and injury/enterotomy. Patients with clinical leak were not more likely to have air leaks on intraoperative air leak testing.ConclusionsIn diverted anastomoses, most leaks become clinically apparent beyond 30 days. The standard practice of censoring outcomes that occur beyond postoperative day 30 will fail to identify a substantial fraction of leaks in diverted colorectal anastomoses.

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