Relation between postoperative ileus and anastomotic leakage after colorectal resection: a post hoc analysis of a prospective randomized controlled trial

Colorectal Dis. 2017 Jul;19(7):667-674. doi: 10.1111/codi.13582.


Aim: Anastomotic leakage (AL) following abdominal surgery is a critical determinant of postoperative recovery, of which the aetiology is largely unknown. Interestingly, interventions aimed at reducing the inflammatory response and postoperative ileus (POI) have an unexpected effect on AL. The aim of this study was to investigate the relation of POI with inflammation and AL after colorectal resection.

Method: A post hoc analysis of a prospective randomized controlled trial in which patients underwent a colorectal resection was performed. Patients undergoing a colorectal resection were stratified into having or not having POI. The incidence of AL and other clinical parameters was registered prospectively. Intestinal fatty acid binding protein (I-FABP, a marker for tissue damage) and the inflammatory response in plasma and colon tissue were determined.

Results: AL was present in nine of 43 patients in the POI group, and in one of 65 in the group without POI (P < 0.001). There was a significant association between POI and AL (OR 12.57, 95% CI: 2.73-120.65; P = 0.0005). Patients with POI had significantly higher plasma levels of soluble tumour necrosis factor receptor 1 (TNFRSF1A) at 4 h postoperatively (0.89 ng/l, interquartile range 0.56) than patients without POI (0.80 ng/l, interquartile range 0.37; P = 0.04) and higher plasma levels of C-reactive protein on the second day postoperatively (234 ± 77 vs 163 ± 86 mg/l; P = 0.001). Patients who developed AL had significantly higher plasma levels of I-FABP compared with patients without AL at 24 h after onset of surgery.

Conclusion: POI is associated with a higher prevalence of AL and an increased inflammatory response.

Keywords: Anastomotic leakage; I-FABP; colorectal surgery; inflammation; postoperative ileus; surgical complications.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Anastomotic Leak / blood
  • Anastomotic Leak / epidemiology
  • Anastomotic Leak / etiology*
  • C-Reactive Protein / analysis
  • Colectomy / adverse effects*
  • Colonic Diseases / blood
  • Colonic Diseases / epidemiology
  • Colonic Diseases / etiology*
  • Colorectal Neoplasms / surgery
  • Fatty Acid-Binding Proteins / analysis
  • Female
  • Humans
  • Ileus / blood
  • Ileus / epidemiology
  • Ileus / etiology*
  • Incidence
  • Male
  • Middle Aged
  • Postoperative Complications*
  • Prospective Studies
  • Risk Factors


  • Fatty Acid-Binding Proteins
  • C-Reactive Protein