Risk of clinical leak after laparoscopic versus open bowel anastomosis

This study was designed to investigate the safety of laparoscopic (Lap) colorectal surgery as reflected by the anastomotic bowel leak (ABL) rate compared with that seen in open surgery. Between 2000 and 2007, 1,516 consecutive patients undergoing Lap-colorectal surgery with bowel anastomosis were covariate-adjusted to 3,258 patients undergoing open surgery by pathology and site of anastomosis using the institutional review board-approved laparoscopic, diverticular, Crohn's, and colorectal cancer databases. Of these patients, 643 patients in each group were equally matched by pathology, site of anastomosis, date of surgery, age, gender, and body mass index. The clinical ABL rate was compared between the two groups by the location of bowel anastomosis and year of surgery. A total of 4,774 patients (1,516 Lap, 3,258 open; mean age, 55.8 +/- A 17.4 years; body mass index, 27.8 +/- A 6.2) underwent colorectal resection with bowel anastomosis (cancer 45.3%, Crohn's 29.6%, diverticulitis 12.3%, other 12.8%). There was no difference in the overall clinical ABL between Lap (2.6%) and open procedures (2.1%; p = 0.5), between Lap right versus open right (p = 0.6), between Lap left versus open left (p = 0.8), and between patients operated on during different time periods (p = 0.4). For the case-matched 643 patients, there were no differences in clinical anastomotic bowel leak between laparoscopic versus open group based on site of anastomosis, pathology, and year of surgery. A laparoscopic colorectal approach is not associated with a higher risk of clinical anastomotic bowel leak.