Background and Goal of Study
Anastomotic leakages (AL) are rare but severe complications of bowel resections. AL occurs in 5% to 10% of bowel resections; its causes are mostly unknown. 
The authors tested the thesis whether or not there is a correlation between low coagulation factor XIII (CFXIII) activity and AL in a prospective observational study.

Methods
Over a period of 6 months, CFXIII activity of patients who were planned to undergo bowel resection was monitored. CFXIII activity was determined at three stages: (1) directly before the surgery, (2) on the first postoperative (PO) day and (3) on the fifth PO day. After fifteen days patients were divided into two groups: (a) a “no-leakage”-group and (b) a “leakage” group. CFXIII activity is given as percentage (normal range 70% to 120%).  The medians of the two groups were then compared using the Mann-Whitney-U-Test.

Results and Discussion
Of the 78 patients who were included in the study 4 showed signs of AL and had to undergo surgical revision. In the “leakage”-group CFXIII activity was significantly lower than in the “no-leakage”-group on the first (median 41% vs 56%, p=0.013) and fifth (median 21% vs 50%, p=0.001) PO day. 
Also, the preoperative CFXIII activity was lower in the “leakage”-group but our study does not show a statistically significant correlation (median 60% vs 69%, p= 0.213).

Conclusions
AL typically occurs around the fifth PO day. Since CFXIII activity is significantly lower in patients who later developed AL on the first PO day already, we draw the conclusion that there is at least a predictive component in CFXIII activity. 
It is also possible that low CFXIII activity is a reason for AL. We plan to conduct a further study to determine whether or not patients benefit from CFXIII substitution prior to bowel resections.

The correlation between low coagulation factor XIII activity and anastomic leakage in patients who undergo bowel resection