Which anastomosis has the highest rate of leakage?

The anastomosis with the highest rate of leakage is the oesophageal anastomosis. This is primarily due to the unique anatomical and physiological characteristics of the oesophagus, as well as the surgical techniques involved in creating the anastomosis.

The oesophagus has a relatively poor blood supply, particularly in the context of anastomosis, which contributes to a higher risk of ischaemia and subsequent leakage at the surgical site. The tension created during the anastomosis can also compromise the vascular supply further, increasing the likelihood of leakage.

Additionally, the oesophagus is subjected to both intraluminal pressure and external forces during swallowing, which can stress the anastomotic site. In contrast, while gastrointestinal and rectal anastomoses can also experience leakage, factors such as better blood supply, lower intraluminal pressures, and generally more favorable healing conditions contribute to their lower leakage rates. Cardiac anastomosis leakage can occur, but it is not usually characterized by the same high rates observed in oesophageal procedures.

Therefore, the oesophageal anastomosis stands out for its elevated risk of leakage, making it a critical consideration during surgical planning and postoperative management.