A Prospective Study of Anastomotic Leak Following Colorectal Surgery in North East Nigeria: Incidence, Risk Factors, and Management

Anastomotic leak after colorectal surgery is a feared complication associated with substantial mortality and prolonged hospital stay. Empirical data on its incidence and management in North East Nigeria are essential for guiding evidence-based practice. This prospective study determines the incidence, risk factors, and management of anastomotic leak following colorectal resection and anastomosis at a tertiary hospital in Gombe State, North East Nigeria, from 2020 to 2023. A total of 145 patients undergoing elective and emergency colorectal surgery with primary anastomosis were prospectively enrolled. Daily clinical monitoring for anastomotic leak was conducted using clinical and radiological parameters. Anastomotic leak was defined per the International Study Group criteria. Risk factor analysis was performed using multivariable logistic regression. Anastomotic leak occurred in 9.7% of patients. Independent risk factors included emergency surgery (OR 3.4), preoperative haemoglobin below 8 g/dL (OR 2.9), distal rectal anastomosis (OR 4.2), and absence of a defunctioning stoma (OR 2.7). Management required re-operation in 64% of leak cases. Mortality in patients with anastomotic leak was 28.6%. The study provides an evidence base for optimizing colorectal anastomosis in North East Nigeria, recommending preoperative anaemia correction, liberal defunctioning stoma use in high-risk cases, and structured anastomotic leak pathways. Keywords: anastomotic leak, colorectal surgery, risk factors, Gombe, surgical complication