Primary Anastomosis After Emergency Small-Bowel Resection: Safety, Outcomes, and the Role of Hypoalbuminemia in a 270-Patient Cohort

Abstract

Aim: Emergency small bowel resections are complex procedures performed under life-threatening conditions such as ischemia, perforation, or trauma. The decision between primary anastomosis and fecal diversion is critical, with anastomotic leakage posing a significant risk to patient outcomes. This study aims to evaluate the safety and feasibility of primary anastomosis in emergency small bowel resections and to identify potential predictors of leakage.Material and Methods: This retrospective cohort study was conducted at Ankara Etlik City Hospital, including patients aged ≥18 years who underwent emergency small bowel resection from January 2023 to December 2024. Elective cases and incomplete records were excluded. Primary outcomes included anastomotic leakage and 30-day mortality, while secondary outcomes assessed surgical approach, technique, and complications. Descriptive statistics, chi-square tests, and multivariate logistic regression were utilized for analysis.Results: A total of 270 patients (54.4% male, mean age 59.4 years) underwent emergency small bowel resection, with 95.9% undergoing open surgery. Stapled anastomoses were used in 72.2% of cases. The anastomotic leak rate was 5.9%, and 30-day mortality was notably high at 25.9%. Regression analysis identified no significant predictors of leakage, including age (p = 0.724), sex (p = 0.963), surgical technique (p = 0.634), or serum albumin levels (p = 0.580). Leak rates did not differ significantly between hypoalbuminemic and non-hypoalbuminemic patients (p = 0.999).Conclusion: Primary anastomosis in emergency small bowel resections is safe and feasible, with a 5.9% leak rate comparable to existing literature. Hypoalbuminemia and anastomosis technique did not significantly impact leak risk, suggesting both stapled and hand-sewn methods are effective. This study challenges the existing literature by demonstrating that hypoalbuminemia, traditionally considered a risk factor for anastomotic leakage, did not significantly impact leak rates in our large cohort of 270 cases.