Anastomotic Leak and Length of Stay After Colorectal Resection with Primary Anastomosis: Open Versus Laparoscopic Surgery - A Single-Center Retrospective Study

Horváth RS*, Gozman-Pop A, Epres J, Korcsok A, Rózsa A, Maghiar TA, Maghiar OA, Maghiar PB and Maghiar MA
 

Doctoral School of Biomedical Sciences, University of Oradea, Romania
Békés County Central Hospital, Gyula, Hungary
Bihor County Emergency Hospital, Oradea, Romania
Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, Romania

^*Correspondance to: Horvath Roland-Sebastian 

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Abstract:

Background and Aim: Anastomotic Leak (AL) are a major complication after colorectal surgery and a key driver of prolonged length of Stay (LOS). To compare AL incidence and LOS between open and laparoscopic colorectal surgery, quantify the impact of AL on LOS overall and by approach, evaluate prolonged LOS (>14 days) as a clinically meaningful hard endpoint, and explore the association between pathological T/N stage and AL. Methods: Retrospective cohort study including 315 patients (185 open, 130 laparoscopic) undergoing colorectal resection with anastomosis at Békés County Central Hospital, Gyula, Hungary (2018-2024). Categorical variables were compared using Fisher's exact test; non-parametric continuous variables using Mann-Whitney U. Effect sizes are reported as Relative Risk (RR) and Odds Ratio (OR) with 95% Confidence Intervals (95% CI). Prolonged LOS was analyzed using logistic regression with predictors: surgical approach and AL. In the 260 patients with complete pathological TNM data, AL rates were compared across T and N categories using the Fisher-Freeman-Halton exact test. Results: AL occurred in 25/315 patients (7.9%), numerically lower after laparoscopy (8/130; 6.2%) than after open surgery (17/185; 9.2%), without statistical significance (Fisher p=0.400; OR 1.54, 95% CI 0.65-3.69). LOS was significantly shorter after laparoscopy (median 6 vs 7 days, p<0.001). AL markedly prolonged LOS (median 17 vs. 7 days, p<0.001) and was the dominant predictor of prolonged hospitalization (>14 days) in the logistic model (adjusted OR 35.02, 95% CI 12.04-101.89, p<0.001), with open surgery also contributing independently (adjusted OR 3.65, 95% CI 1.04-12.80, p=0.043). Among 260 patients with complete TNM data, no significant association was found between pathological T category (p=0.989) or N category (p=0.386) and AL, although N2 disease showed the highest observed leak rate (13.2%). Conclusions: Laparoscopy is associated with shorter LOS and a numerically lower AL rate. AL remains the dominant determinant of prolonged hospitalization, irrespective of surgical approach. Pathological T and N categories were not significantly associated with AL, although these exploratory findings warrant confirmation in larger, prospective, multicenter studies.

Keywords:

 Anastomotic leak; Colorectal surgery; Laparoscopy; Open surgery; Length of stay

Cite the Article:

Horváth RS, Gozman-Pop A, Epres J, Korcsok A, Rózsa A, Maghiar TA, et al. Anastomotic Leak and Length of Stay After Colorectal Resection with Primary Anastomosis: Open Versus Laparoscopic Surgery - A Single-Center Retrospective Study. Clin Case Rep Int. 2026; 10: 1792..