Outcomes of small intestines anastomosis after emergency laparatomy at Kenyatta National Hospital: a prospective longitudinal study
Small intestine anastomosis is one of the commonest procedures in general suJtery. In Kenya where incidence of abdominal trauma is increasing, this procedure is important. At Kenyatta National Hospital (KNH), laparotomy with small intestine anastomosis is one of the most common surgical procedures and yet there has not been a comprehensive review probably because the technique has not been questioned as it is considered a basic skill. Anastomotic failure has always been a cause for concern in patient's under-going surgery with intestinal anastomosis, as it adversely affects the surgical outcome. The consequences of a failed anastomosis are devastating with high morbidity and mortality. Failure of anastomosis with leakages of intestinal contents is still, regrettably, a common surgical experience. Objective This was a prospective longitudinal study to determine the outcomes of emergency laparatomy with small intestine anastomosis at KNH. Materials and methods.This was a prospective longitudinal study carried out at Kenyatta national hospital [KNH]. Sixty nine patients admitted in the general surgical wards who underwent emergency abdominal surgery with smaIl intestine anastomosis were recruited into the study from Sept 2011 to November 2011. The data was collected using a structured questionnaire entered and verified using Microsoft excel. Data analysis was performed using SPSS version 17. Main outcome measures were anastomotic leaks, wound dehiscence, wound sepsis and duration of hospital stay. Results There were 53 males (76.81%) and 16 females (23.91%) giving a male-to-female ratio of 3: 1 and the average age of all patients was 32.5 (SD 13.4) and the age range was from 16 to 76 years. Most (44.93%) patients were aged 2()'29 years. The most common indieation was penetrating abdominal injury which occurred in 35 (50.7%) of all patients in the study. The minimum duration of hospital stay following emergency laparatomy was 4 days and the maximum duration of stay was 28 days. On average patients stayed in hospital for 8.4 days (SD = 4.9) after the emergency laparatomy procedure. The prevalence of anastomotic leakage was 10.1% while 13 (18.8%) developed wound dehiscence and 23.2% developed wound sepsis. Concusion The study found that duration of hospital stay in patients with any of the three complications was significantly longer than that of patients who do not develop complications thus increasing the morbidity .Patient characteristics did not predict the occurrence of surgical complications. The use of intra-peritoneal drain and naso-gastric decompression did not offer added advantage. Surgical technique, whether you use single or double layer, did not influence complications.