The reported incidence of anastomotic leak (AL) following gastric surgery is 5–7% and is 8–20 % for esophageal surgeries.1, 2, 3, 4, 5, 6 AL continues to be a major cause of post-operative morbidity and mortality despite advancements in surgical techniques and use of intraoperative adjuncts like indocyanine green to improve surgical outcomes.1 AL is associated with increased postoperative mortality, longer length of hospital stays, readmissions and greater hospital costs.1, 2, 3, 4 It can also result in chronic complications like fistula formation and recurrent anastomotic strictures4 that worsen long-term health related quality of life.2 In surgical oncology patients, it is associated with increased cancer recurrence and poorer long-term overall survival.4,5

AL remains a diagnostic challenge despite an armamentarium of investigations to aid in the diagnosis. Methylene blue test in the presence of a drain, oral contrast studies, computed tomography (CT) scans and upper gastrointestinal endoscopy are commonly used for identification of AL. Data on their diagnostic accuracy is conflicting.7, 8, 9, 10, 11, 12, 13 While early identification of AL can potentially improve outcomes, a false negative study provides a false sense of assurance thus delaying treatment. Therefore, having a high index of clinical suspicion despite a negative initial investigation seems crucial.

Our study seeks to identify key clinical parameters that are predictive of AL and to evaluate the effectiveness of various investigations for diagnosing AL following UGI surgeries involving anastomosis in our practice.