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Revista Científica do Hospital e Maternidade José Martiniano de Alencar

Artigo Original

Vol. 4 Núm. 2 (2023)

Perfil epidemiológico de pacientes submetidos a cirurgias colorretais e análise da incidência de fístulas anastomóticas em hospital secundário - de 2019 a 2024

DOI
https://doi.org/10.54257/2965-0585.v4.i2.88
Enviado
September 18, 2025
Publicado
2025-09-29

Resumen

Objetivos: A fístula anastomótica é uma das complicações mais graves em uma cirurgia colorretal. O estudo visou traçar um perfil dos pacientes submetidos a cirurgias colorretais e identificar os fatores de risco envolvidos na ocorrência de fístulas. Métodos: Foi realizada revisão dos prontuários de 114 pacientes submetidos a cirurgias colorretais e avaliação dos dados relacionados a sexo, idade, patologia de base, tipo de cirurgia, via de acesso, incidência de fístulas anastomótica, classificação e seu manejo, morbimortalidade. Resultados: A incidência global de fístulas foi de 10,5% e os fatores mais associados a fístulas anastomóticas foram sexo masculino (RR=1,89 IC:95%; 0,54 - 6,59), história de diverticulite aguda (RR 2,03 IC:95%; 0,51 - 6,09), cirurgia laparotômica (RR=2,5 IC:95%; 0,8 - 8,3) e anastomose envolvendo o reto (RR=2,8 IC:95%; 0,8 - 9,8). O tratamento conservador foi a principal abordagem (50%), seguida da reabordagem (41,7%) e a menor parte foi manejada com drenagem percutânea (8,3%). A mortalidade e letalidade foram respectivamente de 0,87% e 8,3%. Conclusões: A análise dos dados sugere que sexo masculino, pacientes com história de diverticulite aguda, anastomose baixa e cirurgia laparotômica sejam os fatores mais associados ao desenvolvimento de fístulas anastomóticas, todavia sem significância estatística. A incidência geral de fístulas é ligeiramente menor que os valores encontrados na literatura mundial, enquanto a mortalidade está bem abaixo do esperado, o que reforça a excelência e experiência deste serviço na realização deste tipo de cirurgia. O tratamento conservador foi suficiente na maioria dos casos.

Citas

  1. Spanjersberg WR, et al. Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev. 2011;
  2. Chiarella MM, et al. Anastomotic leakage in colorectal cancer surgery. Surg Oncol. 2022;40:101708.
  3. Tsang Y, Chen W. Management of anastomotic leakage after rectal surgery: a review article. J Gastrointest Oncol. 2019;10.
  4. Vallance A, et al. A collaborative review of the current concepts and challenges of anastomotic leaks in colorectal surgery. Colorectal Dis. 2017;19(1):O1–12. doi:10.1111/codi.13534. PMID: 27671222.
  5. Denicu MM, et al. Anastomotic leakage after colorectal surgery: risk factors, diagnosis and therapeutic options. Curr Health Sci J. 2023;49(3):333–42. doi:10.12865/CHSJ.49.03.05.
  6. Beck C, et al. The influence of postoperative complications on long-term prognosis in patients with colorectal carcinoma. Int J Colorectal Dis. 2020;35(6):1055–66. doi:10.1007/s00384-020-03557-3.
  7. Kauv P, et al. Anastomotic leakage after colorectal surgery: diagnostic accuracy of CT. Eur Radiol. 2015;25(12):3543–51.
  8. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13. doi:10.1097/01.sla.0000133083.54934
  9. Rahbari NN, et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery. 2010;147(3):339–51.
  10. Turrentine FE, et al. Morbidity, mortality, cost, and survival estimates of gastrointestinal anastomotic leaks. J Am Coll Surg. 2015;220(2):195–206.
  11. Zhang W, et al. Multicenter analysis of risk factors for anastomotic leakage after middle and low rectal cancer resection without diverting stoma: a retrospective study of 319 consecutive patients. Int J Colorectal Dis. 2017;32(10):1431–7. doi:10.1007/s00384-017-2875-8.
  12. Toyoshima A, et al. Narrow pelvic inlet plane area and obesity as risk factors for anastomotic leakage after intersphincteric resection. World J Gastrointest Surg. 2020;12(10):425–34. doi:10.4240/wjgs.v12.i10.425. PMID: 33194091; PMCID: PMC7642346.
  13. Alekseev M, et al. Intraoperative fluorescence angiography as an independent factor of anastomotic leakage and a nomogram for predicting leak for colorectal anastomoses. Ann Coloproctol. 2022;38:380–6.
  14. Kim MJ, et al. The impact of heavy smoking on anastomotic leakage and stricture after low anterior resection in rectal cancer patients. World J Surg. 2011;35:2806–11.
  15. Kwag SJ, et al. The nutritional risk is an independent factor for postoperative morbidity in surgery for colorectal cancer. Ann Surg Treat Res. 2014;86(4):206–11.
  16. Slim K, et al. Intolerance to early oral feeding in enhanced recovery after colorectal surgery: an early red flag? Colorectal Dis. 2020;22(1).
  17. Bonjer HJ, et al. A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med. 2015;372(14):1324–32. doi:10.1056/NEJMoa1414882.
  18. Juo YY, et al. Is minimally invasive colon resection better than traditional approaches? First comprehensive national examination with propensity score matching. JAMA Surg. 2014;149:177–84. doi:10.1001/jamasurg.2013.3660.
  19. Krarup PM, et al. A nationwide study on anastomotic leakage after colonic cancer surgery. Colorectal Dis. 2012;14:e661–7. doi:10.1111/j.1463-1318.2012.03079
  20. Ellis CT, Maykel JA. Defining anastomotic leak and the clinical relevance of leaks. Clin Colon Rectal Surg. 2021;34(6):359–65. doi:10.1055/s-0041-1735265.
  21. Guerra F, et al. A meta-analysis of randomized controlled trials on the use of suction drains following rectal surgery. Dig Surg. 2018;35:482–90. doi:10.1159/000485139.
  22. Montedori A, et al. Covering ileo- or colostomy in anterior resection for rectal carcinoma. Cochrane Database Syst Rev. 2010;(5):CD006878. doi:10.1002/14651858.CD006878.pub2. PMID: 20464746.
  23. Sparreboom CL, van Groningen JT, Lingsma HF, Wouters MWJM, Menon AG, Kleinrensink GJ, Jeekel J, Lange JF; Dutch ColoRectal Audit group. Different risk factors for early and late colorectal anastomotic leakage in a nationwide audit. Dis Colon Rectum. 2018;61(11):1258–66. doi:10.1097/DCR.0000000000001202. PMID: 30239395.
  24. McKechnie T, et al. Double-row staple technology versus triple-row staple technology for colorectal surgery: a systematic review and meta-analysis. Surgery. 2024;176(3):633–44. doi:10.1016/j.surg.2024.04.039. Epub 2024 Jun 13. PMID: 38876899.
  25. Balciscueta Z, et al. Impact of the number of stapler firings on anastomotic leakage in laparoscopic rectal surgery: a systematic review and meta-analysis. Tech Coloproctol. 2020;24(9):919–25. doi:10.1007/s10151-020-02240-7.
  26. Shen R, Zhang Y, Wang T. Indocyanine green fluorescence angiography and the incidence of anastomotic leak after colorectal resection for colorectal cancer: a meta-analysis. Dis Colon Rectum. 2018;61(10):1228–34.
  27. Ris F, et al. Multicentre phase II trial of near-infrared imaging in elective colorectal surgery. Br J Surg. 2018;105:1359–67. doi:10.1002/bjs.10844.
  28. Heimroth J, Chen E, Sutton E. Management approach for enterocutaneous fistula. Am Surg. 2018;84:326–33.
  29. McArdle CS, McMillan DC, Hole DJ. Impact of anastomotic leakage on long-term survival of patients undergoing curative resection for colorectal cancer. Br J Surg. 2005;92(9):1150–4. doi:10.1002/bjs.5054. PMID: 16035134.

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