\documentclass[11pt,twoside]{article}\makeatletter

\IfFileExists{xcolor.sty}%
  {\RequirePackage{xcolor}}%
  {\RequirePackage{color}}
\usepackage{colortbl}
\usepackage{wrapfig}
\usepackage{ifxetex}
\ifxetex
  \usepackage{fontspec}
  \usepackage{xunicode}
  \catcode`⃥=\active \def⃥{\textbackslash}
  \catcode`❴=\active \def❴{\{}
  \catcode`❵=\active \def❵{\}}
  \def\textJapanese{\fontspec{Noto Sans CJK JP}}
  \def\textChinese{\fontspec{Noto Sans CJK SC}}
  \def\textKorean{\fontspec{Noto Sans CJK KR}}
  \setmonofont{DejaVu Sans Mono}
  
\else
  \IfFileExists{utf8x.def}%
   {\usepackage[utf8x]{inputenc}
      \PrerenderUnicode{–}
    }%
   {\usepackage[utf8]{inputenc}}
  \usepackage[english]{babel}
  \usepackage[T1]{fontenc}
  \usepackage{float}
  \usepackage[]{ucs}
  \uc@dclc{8421}{default}{\textbackslash }
  \uc@dclc{10100}{default}{\{}
  \uc@dclc{10101}{default}{\}}
  \uc@dclc{8491}{default}{\AA{}}
  \uc@dclc{8239}{default}{\,}
  \uc@dclc{20154}{default}{ }
  \uc@dclc{10148}{default}{>}
  \def\textschwa{\rotatebox{-90}{e}}
  \def\textJapanese{}
  \def\textChinese{}
  \IfFileExists{tipa.sty}{\usepackage{tipa}}{}
\fi
\def\exampleFont{\ttfamily\small}
\DeclareTextSymbol{\textpi}{OML}{25}
\usepackage{relsize}
\RequirePackage{array}
\def\@testpach{\@chclass
 \ifnum \@lastchclass=6 \@ne \@chnum \@ne \else
  \ifnum \@lastchclass=7 5 \else
   \ifnum \@lastchclass=8 \tw@ \else
    \ifnum \@lastchclass=9 \thr@@
   \else \z@
   \ifnum \@lastchclass = 10 \else
   \edef\@nextchar{\expandafter\string\@nextchar}%
   \@chnum
   \if \@nextchar c\z@ \else
    \if \@nextchar l\@ne \else
     \if \@nextchar r\tw@ \else
   \z@ \@chclass
   \if\@nextchar |\@ne \else
    \if \@nextchar !6 \else
     \if \@nextchar @7 \else
      \if \@nextchar (8 \else
       \if \@nextchar )9 \else
  10
  \@chnum
  \if \@nextchar m\thr@@\else
   \if \@nextchar p4 \else
    \if \@nextchar b5 \else
   \z@ \@chclass \z@ \@preamerr \z@ \fi \fi \fi \fi
   \fi \fi  \fi  \fi  \fi  \fi  \fi \fi \fi \fi \fi \fi}
\gdef\arraybackslash{\let\\=\@arraycr}
\def\@textsubscript#1{{\m@th\ensuremath{_{\mbox{\fontsize\sf@size\z@#1}}}}}
\def\Panel#1#2#3#4{\multicolumn{#3}{){\columncolor{#2}}#4}{#1}}
\def\abbr{}
\def\corr{}
\def\expan{}
\def\gap{}
\def\orig{}
\def\reg{}
\def\ref{}
\def\sic{}
\def\persName{}\def\name{}
\def\placeName{}
\def\orgName{}
\def\textcal#1{{\fontspec{Lucida Calligraphy}#1}}
\def\textgothic#1{{\fontspec{Lucida Blackletter}#1}}
\def\textlarge#1{{\large #1}}
\def\textoverbar#1{\ensuremath{\overline{#1}}}
\def\textquoted#1{‘#1’}
\def\textsmall#1{{\small #1}}
\def\textsubscript#1{\@textsubscript{\selectfont#1}}
\def\textxi{\ensuremath{\xi}}
\def\titlem{\itshape}
\newenvironment{biblfree}{}{\ifvmode\par\fi }
\newenvironment{bibl}{}{}
\newenvironment{byline}{\vskip6pt\itshape\fontsize{16pt}{18pt}\selectfont}{\par }
\newenvironment{citbibl}{}{\ifvmode\par\fi }
\newenvironment{docAuthor}{\ifvmode\vskip4pt\fontsize{16pt}{18pt}\selectfont\fi\itshape}{\ifvmode\par\fi }
\newenvironment{docDate}{}{\ifvmode\par\fi }
\newenvironment{docImprint}{\vskip 6pt}{\ifvmode\par\fi }
\newenvironment{docTitle}{\vskip6pt\bfseries\fontsize{22pt}{25pt}\selectfont}{\par }
\newenvironment{msHead}{\vskip 6pt}{\par}
\newenvironment{msItem}{\vskip 6pt}{\par}
\newenvironment{rubric}{}{}
\newenvironment{titlePart}{}{\par }

\newcolumntype{L}[1]{){\raggedright\arraybackslash}p{#1}}
\newcolumntype{C}[1]{){\centering\arraybackslash}p{#1}}
\newcolumntype{R}[1]{){\raggedleft\arraybackslash}p{#1}}
\newcolumntype{P}[1]{){\arraybackslash}p{#1}}
\newcolumntype{B}[1]{){\arraybackslash}b{#1}}
\newcolumntype{M}[1]{){\arraybackslash}m{#1}}
\definecolor{label}{gray}{0.75}
\def\unusedattribute#1{\sout{\textcolor{label}{#1}}}
\DeclareRobustCommand*{\xref}{\hyper@normalise\xref@}
\def\xref@#1#2{\hyper@linkurl{#2}{#1}}
\begingroup
\catcode`\_=\active
\gdef_#1{\ensuremath{\sb{\mathrm{#1}}}}
\endgroup
\mathcode`\_=\string"8000
\catcode`\_=12\relax

\usepackage[a4paper,twoside,lmargin=1in,rmargin=1in,tmargin=1in,bmargin=1in,marginparwidth=0.75in]{geometry}
\usepackage{framed}

\definecolor{shadecolor}{gray}{0.95}
\usepackage{longtable}
\usepackage[normalem]{ulem}
\usepackage{fancyvrb}
\usepackage{fancyhdr}
\usepackage{graphicx}
\usepackage{marginnote}

\renewcommand{\@cite}[1]{#1}


\renewcommand*{\marginfont}{\itshape\footnotesize}

\def\Gin@extensions{.pdf,.png,.jpg,.mps,.tif}

  \pagestyle{fancy}

\usepackage[pdftitle={Effects of Blood Transfusion in Outcome of Elective Bowel Anastomosis},
 pdfauthor={}]{hyperref}
\hyperbaseurl{}

	 \paperwidth210mm
	 \paperheight297mm
              
\def\@pnumwidth{1.55em}
\def\@tocrmarg {2.55em}
\def\@dotsep{4.5}
\setcounter{tocdepth}{3}
\clubpenalty=8000
\emergencystretch 3em
\hbadness=4000
\hyphenpenalty=400
\pretolerance=750
\tolerance=2000
\vbadness=4000
\widowpenalty=10000

\renewcommand\section{\@startsection {section}{1}{\z@}%
     {-1.75ex \@plus -0.5ex \@minus -.2ex}%
     {0.5ex \@plus .2ex}%
     {\reset@font\Large\bfseries}}
\renewcommand\subsection{\@startsection{subsection}{2}{\z@}%
     {-1.75ex\@plus -0.5ex \@minus- .2ex}%
     {0.5ex \@plus .2ex}%
     {\reset@font\Large}}
\renewcommand\subsubsection{\@startsection{subsubsection}{3}{\z@}%
     {-1.5ex\@plus -0.35ex \@minus -.2ex}%
     {0.5ex \@plus .2ex}%
     {\reset@font\large}}
\renewcommand\paragraph{\@startsection{paragraph}{4}{\z@}%
     {-1ex \@plus-0.35ex \@minus -0.2ex}%
     {0.5ex \@plus .2ex}%
     {\reset@font\normalsize}}
\renewcommand\subparagraph{\@startsection{subparagraph}{5}{\parindent}%
     {1.5ex \@plus1ex \@minus .2ex}%
     {-1em}%
     {\reset@font\normalsize\bfseries}}


\def\l@section#1#2{\addpenalty{\@secpenalty} \addvspace{1.0em plus 1pt}
 \@tempdima 1.5em \begingroup
 \parindent \z@ \rightskip \@pnumwidth 
 \parfillskip -\@pnumwidth 
 \bfseries \leavevmode #1\hfil \hbox to\@pnumwidth{\hss #2}\par
 \endgroup}
\def\l@subsection{\@dottedtocline{2}{1.5em}{2.3em}}
\def\l@subsubsection{\@dottedtocline{3}{3.8em}{3.2em}}
\def\l@paragraph{\@dottedtocline{4}{7.0em}{4.1em}}
\def\l@subparagraph{\@dottedtocline{5}{10em}{5em}}
\@ifundefined{c@section}{\newcounter{section}}{}
\@ifundefined{c@chapter}{\newcounter{chapter}}{}
\newif\if@mainmatter 
\@mainmattertrue
\def\chaptername{Chapter}
\def\frontmatter{%
  \pagenumbering{roman}
  \def\thechapter{\@roman\c@chapter}
  \def\theHchapter{\roman{chapter}}
  \def\thesection{\@roman\c@section}
  \def\theHsection{\roman{section}}
  \def\@chapapp{}%
}
\def\mainmatter{%
  \cleardoublepage
  \def\thechapter{\@arabic\c@chapter}
  \setcounter{chapter}{0}
  \setcounter{section}{0}
  \pagenumbering{arabic}
  \setcounter{secnumdepth}{6}
  \def\@chapapp{\chaptername}%
  \def\theHchapter{\arabic{chapter}}
  \def\thesection{\@arabic\c@section}
  \def\theHsection{\arabic{section}}
}
\def\backmatter{%
  \cleardoublepage
  \setcounter{chapter}{0}
  \setcounter{section}{0}
  \setcounter{secnumdepth}{2}
  \def\@chapapp{\appendixname}%
  \def\thechapter{\@Alph\c@chapter}
  \def\theHchapter{\Alph{chapter}}
  \appendix
}
\newenvironment{bibitemlist}[1]{%
   \list{\@biblabel{\@arabic\c@enumiv}}%
       {\settowidth\labelwidth{\@biblabel{#1}}%
        \leftmargin\labelwidth
        \advance\leftmargin\labelsep
        \@openbib@code
        \usecounter{enumiv}%
        \let\p@enumiv\@empty
        \renewcommand\theenumiv{\@arabic\c@enumiv}%
	}%
  \sloppy
  \clubpenalty4000
  \@clubpenalty \clubpenalty
  \widowpenalty4000%
  \sfcode`\.\@m}%
  {\def\@noitemerr
    {\@latex@warning{Empty `bibitemlist' environment}}%
    \endlist}

\def\tableofcontents{\section*{\contentsname}\@starttoc{toc}}
\parskip0pt
\parindent1em
\def\Panel#1#2#3#4{\multicolumn{#3}{){\columncolor{#2}}#4}{#1}}
\newenvironment{reflist}{%
  \begin{raggedright}\begin{list}{}
  {%
   \setlength{\topsep}{0pt}%
   \setlength{\rightmargin}{0.25in}%
   \setlength{\itemsep}{0pt}%
   \setlength{\itemindent}{0pt}%
   \setlength{\parskip}{0pt}%
   \setlength{\parsep}{2pt}%
   \def\makelabel##1{\itshape ##1}}%
  }
  {\end{list}\end{raggedright}}
\newenvironment{sansreflist}{%
  \begin{raggedright}\begin{list}{}
  {%
   \setlength{\topsep}{0pt}%
   \setlength{\rightmargin}{0.25in}%
   \setlength{\itemindent}{0pt}%
   \setlength{\parskip}{0pt}%
   \setlength{\itemsep}{0pt}%
   \setlength{\parsep}{2pt}%
   \def\makelabel##1{\upshape ##1}}%
  }
  {\end{list}\end{raggedright}}
\newenvironment{specHead}[2]%
 {\vspace{20pt}\hrule\vspace{10pt}%
  \phantomsection\label{#1}\markright{#2}%

  \pdfbookmark[2]{#2}{#1}%
  \hspace{-0.75in}{\bfseries\fontsize{16pt}{18pt}\selectfont#2}%
  }{}
      \def\TheFullDate{2012-09-22 (revised: 22 September 2012)}
\def\TheID{\makeatother }
\def\TheDate{2012-09-22}
\title{Effects of Blood Transfusion in Outcome of Elective Bowel Anastomosis}
\author{}\makeatletter 
\makeatletter
\newcommand*{\cleartoleftpage}{%
  \clearpage
    \if@twoside
    \ifodd\c@page
      \hbox{}\newpage
      \if@twocolumn
        \hbox{}\newpage
      \fi
    \fi
  \fi
}
\makeatother
\makeatletter
\thispagestyle{empty}
\markright{\@title}\markboth{\@title}{\@author}
\renewcommand\small{\@setfontsize\small{9pt}{11pt}\abovedisplayskip 8.5\p@ plus3\p@ minus4\p@
\belowdisplayskip \abovedisplayskip
\abovedisplayshortskip \z@ plus2\p@
\belowdisplayshortskip 4\p@ plus2\p@ minus2\p@
\def\@listi{\leftmargin\leftmargini
               \topsep 2\p@ plus1\p@ minus1\p@
               \parsep 2\p@ plus\p@ minus\p@
               \itemsep 1pt}
}
\makeatother
\fvset{frame=single,numberblanklines=false,xleftmargin=5mm,xrightmargin=5mm}
\fancyhf{} 
\setlength{\headheight}{14pt}
\fancyhead[LE]{\bfseries\leftmark} 
\fancyhead[RO]{\bfseries\rightmark} 
\fancyfoot[RO]{}
\fancyfoot[CO]{\thepage}
\fancyfoot[LO]{\TheID}
\fancyfoot[LE]{}
\fancyfoot[CE]{\thepage}
\fancyfoot[RE]{\TheID}
\hypersetup{citebordercolor=0.75 0.75 0.75,linkbordercolor=0.75 0.75 0.75,urlbordercolor=0.75 0.75 0.75,bookmarksnumbered=true}
\fancypagestyle{plain}{\fancyhead{}\renewcommand{\headrulewidth}{0pt}}

\date{}
\usepackage{authblk}

\providecommand{\keywords}[1]
{
\footnotesize
  \textbf{\textit{Index terms---}} #1
}

\usepackage{graphicx,xcolor}
\definecolor{GJBlue}{HTML}{273B81}
\definecolor{GJLightBlue}{HTML}{0A9DD9}
\definecolor{GJMediumGrey}{HTML}{6D6E70}
\definecolor{GJLightGrey}{HTML}{929497} 

\renewenvironment{abstract}{%
   \setlength{\parindent}{0pt}\raggedright
   \textcolor{GJMediumGrey}{\rule{\textwidth}{2pt}}
   \vskip16pt
   \textcolor{GJBlue}{\large\bfseries\abstractname\space}
}{%   
   \vskip8pt
   \textcolor{GJMediumGrey}{\rule{\textwidth}{2pt}}
   \vskip16pt
}

\usepackage[absolute,overlay]{textpos}

\makeatother 
      \usepackage{lineno}
      \linenumbers
      
\begin{document}

             \author[1]{Abdallah Y A  Ahmed}

\renewcommand\Authands{ and }

\date{\small \em Received: 14 August 2012 Accepted: 8 September 2012 Published: 22 September 2012}

\maketitle


\begin{abstract}
        


Background : Bowel anastomosis is one of the commonest procedure done in surgical practice, and its outcome influence by many factors include; patients, technical, and operation basis, but intraoperative blood transfusion (BT) is discriminated from other risk factors in that; its intentionally added risk factor. Objective : To evaluate the effect of blood transfusion in outcome of elective bowel anastomosis in Khartoum teaching hospital. Patient And Method : Twenty eight patients admitted into Khartoum teaching hospital, and underwent elective bowel anastomosis were enrolled in the study. Data was collected by questionnaire for each patient.Result : The total number of patients was 28, 18 were male and 10 were female, mean age was 50 years, 14.3% were underwent small bowel anastomosis, 85.7% were underwent large bowel anstomosis, and 35.7% were transfused intraoperatively. Regardless other risk factors the incidence of surgical site infection (SSI) was significantly high in transfused patients, in comparison to nontransfued 30% vs 0.0%, also there was a high rates of other complications in transfused patients than those weren't. Conclusion :Intraoperative blood transfusion is a good predictor for development of complications in elective bowel anastomosis.

\end{abstract}


\keywords{transfusion, anastomosis, patient, technical, surgical practice, risk factors.}

\begin{textblock*}{18cm}(1cm,1cm) % {block width} (coords) 
\textcolor{GJBlue}{\LARGE Global Journals \LaTeX\ JournalKaleidoscope\texttrademark}
\end{textblock*}

\begin{textblock*}{18cm}(1.4cm,1.5cm) % {block width} (coords) 
\textcolor{GJBlue}{\footnotesize \\ Artificial Intelligence formulated this projection for compatibility purposes from the original article published at Global Journals. However, this technology is currently in beta. \emph{Therefore, kindly ignore odd layouts, missed formulae, text, tables, or figures.}}
\end{textblock*}


\let\tabcellsep& 	 	 		 
\section[{I. Introduction}]{I. Introduction}\par
fter discovery of ABO group, blood transfusion have become a common treatment for anemia and acute blood loss, its adverse effects had been notice in last decades, especially the immunosuprresion one. \hyperref[b0]{1} Blood transfusion alter both local and systemic immune response to injury, it impair lymphocyte and macrophage function, blastogenesis and interaction with other cells. Allogeneic leukocytes have a critical role in the induction of transfusion-induced immunosuppression, also BT decrease the production of interleukin -2 (IL2) which found to be an important factor in cell immunity and stimulation of healing. \hyperref[b0]{1,} {\ref 2,}\hyperref[b2]{3} These effects can be reverse by administration of exogenous IL2 in chronic healing, also some studies found that leucocytes-depleted blood doesn't impair healing. \hyperref[b2]{3,}\hyperref[b3]{4,}\hyperref[b4]{5} In bowel anastomosis blood transfusion increase incidence of abscess formation, reduce Author : MBBS University of Gezira, June 2004, Senior registrar of general surgery, Sudanese medical specialization board (SMSB) Khartoum , Sudan. E-mail : normal\textunderscore 21sr@hotmail.com collagen synthesis result in impair anastomotic strength, and high rate of anastomotic leak (AL). \hyperref[b0]{1,} {\ref 2,}\hyperref[b2]{3,}\hyperref[b3]{4,}\hyperref[b5]{6,}\hyperref[b6]{7,}\hyperref[b7]{8} Some studies reported that this effect related to intra and postoperative BT rather than preoperative transfusion, implies that its effect might be at least partially surrogated by other intraoperative factors, such as contamination and shock. 2,9, \hyperref[b9]{10} Testini et al study found that; preoperative blood transfusion a causative factor in development of AL. \hyperref[b10]{11,}\hyperref[b13]{15} Also some study found that; high rate of complications related to massive blood transfusion in emergencies. \hyperref[b11]{12,}\hyperref[b12]{13,} {\ref 14} Nevertheless blood transfusions are frequently required in gastrointestinal surgery to correct anemia or because of excessive blood loss from associated trauma or operative procedures. Thus, it is important to establish the effect of such transfusions on intestinal repair. 
\section[{II. Patients and Methods}]{II. Patients and Methods}\par
This a prospective descriptive hospital base clinical study, conducted in Khartoum teaching hospital (KTH), which is the biggest tertiary hospital in Khartoum, the capital of the Sudan, in the period from 15 th Sep 2011 to Aug 1 st 2012.\par
A total of twenty eight patients underwent elective bowel anastomosis, by general surgical units in (KTH) were enrolled in the study after consented. All large bowel anastomosis were preceded by bowel preparation, and all patients received single prophylactic dose of antibiotic, followed by a therapeutic course in postoperative period. Data was collected by structure questionnaire for each patient, from the date of operation till discharge from the hospital and for outpatient follow up for presence of complications, for at least first outpatient visit, variables included were; personal data, diagnosis, operative details, BT regardless the amount, presence of complications, postoperative bowel rest and hospital stay periods. Patients aged below twelve years, or had severe comorbidies were excluded from the study. Data was analyzed by computer using Statistical Package for Social Science (SPSS) program, version (16). 
\section[{III. Results}]{III. Results}\par
Data analysis of twenty eight patients was done, all patients were underwent open, hand sewn elective Result: The total number of patients was 28, 18 were male and 10 were female, mean age was 50years, 14.3\% were underwent small bowel anastomosis, 85.7\% were underwent large bowel anstomosis, and 35.7\% were transfused intraoperatively. Regardless other risk factors the incidence of surgical site infection (SSI) was significantly high in transfused patients, in comparison to nontransfued 30\% vs 0.0\%, also there was a high rates of other complications in transfused patients than those weren't. Conclusion: Intraoperative blood transfusion is a good predictor for development of complications in elective bowel anastomosis.\par
female, mean age was 50.39 years (±15.17) and rang from 22 to 75 years.\par
The indication of anastomosis was resection of bowel tumors in 64.3\% (n=18) of patients; one was small bowel and 17 were large bowel tumors, in 28.5\% (n=10) the indication was reversal of stoma; eight were colostomies and two were ileostomies, in one patient the indication was Crohns disease and in another one was chronic small bowel fistula.\par
Enteroenteric anastomosis was done in 14.3\% of patients, enterocolonic in 50\% and colocolonic in 35.7\% of anastomosis, 85.7\%(n=24) of anastomosis were accomplished by double layer technique and 14.3\%(n=4) by single layer, sutures material was polyglycolic acid and needle was round bodied in all anastomosis.\par
Regarding blood transfusion 35.7\% of patients were received whole blood intraoperatively, and 64.3\% weren't transfused, we weren't considered the amount of blood. Contamination was presented in 21.4\% of patients during operation.\par
Considering complications, the incidence of SSI was 10.7\% (n=3), AL 3.6\% (n=1), fistula 3.6\%, and death 3.6\%. All intraabdonial complications were developed in patients who were transfused intraoperatively.\par
Drainage of peritoneal cavity was done in 62.9\% of operations, and 50\% had nasogastric tube (NGT) decompression. 
\section[{IV. Discussion}]{IV. Discussion}\par
The effect of blood transfusion (BT) in outcome of bowel anastomosis has been investigated by many studies, which proved its adverse impact in healing process and immunity of the host, that result in high rate of infectious complications and leakage, but it's necessary in certain circumstances such as shock and massive resection etc. \hyperref[b0]{[1]} {\ref [2]}\hyperref[b2]{[3]}\hyperref[b3]{[4]}\hyperref[b4]{[5]}\hyperref[b5]{[6]}\hyperref[b6]{[7]}\hyperref[b7]{[8]}\hyperref[b8]{[9]}\hyperref[b9]{[10]}\hyperref[b10]{[11]}\hyperref[b11]{[12]}\hyperref[b12]{[13]} {\ref [14]} In our study all three SSI were developed in transfused group, with rate of 30\% among this group (p=0.014), which found to be a strong association, also in this group AL rate was 10\% , fistula 10\%, and mortality rate was 10\%, and all other complications were developed in this group, which cited blood transfusion a cause in this group. (table2)\par
As other risk factors for complications such as malnutrition, cardiovascular and respiratory diseases weren't showed any significant difference in their rates between two groups, even some risk factors showed a higher rate in nontransfused group such as chemotherapy, smoking and alcohol abuse.(table1) In some studies the amount of blood found to be the risk (massive BT), rather than transfusion itself, unfortunately in our study we weren't considered neither the amount of blood nor intra operative hemorrhage degree as a separate risk factors for development of complications, Intraoperative contamination was found to be high in transfused group than nontransfued 30\% vs 16.7\%, which added a burden into this group, also our analysis revealed a strong association between BT and peritoneal drainage (p=0.007), all patients received blood also were had a drain, but there was no significant association between peritoneal drainage and development of complications, it looks as surgeons were anticipated the development of AL in those patients received intraoperative whole blood. In Ketan et al study all AL were developed in transfused patients. \hyperref[b2]{3} Lujan et al study found that; SSI and intraoperative blood transfusions were also associated with significantly higher rates of AL. \hyperref[b6]{7} Enterocolonic and colocolonic anastomosis followed by all SSI, fistula and leak in this study, and enteroenteric anastomosis wasn't developed complications, concluded the adverse effect of BT is more obvious in large bowel procedures than small bowel, this evidence was supported by Reiping et al study in large bowel anastomosis, also this study concluded that; BT is risk factor for SSI regardless the site of anastomosis in large bowel procedures.  {\ref 2} Considering postoperative fasting period there was no significant difference between two groups, the mean periods were four day in transfused patients, and five days in nontransfused, and hospital stay period was prolonged in transfused group, which was 11.56 days vs 8.22 days in nontrasfused group, which found to be increased proportionally with development of complications.\par
There were some limitations in this study, as other risk factors might change the outcome by adding some burden into one group, and the effect of blood amount wasn't considered, so more precise studies have to be done to give more support to our results. 
\section[{V. In Conclusion}]{V. In Conclusion}\par
Intraoperative blood transfusion has adverse effects in elective bowel anastomosis, significantly increase rate of SSI; also it's a good predictor for development of other complications. 
\section[{VI. Aknownlagment}]{VI. Aknownlagment}\par
My thanks to all member of general surgical uints in Khartoum Teaching Hospital, who help me in data collection,and to my boss Mr. Salah Nori who supported me throughout the study. and how much they affect the outcome was not provided in our results and analysis. \hyperref[b11]{12,}\hyperref[b12]{13,} {\ref 14} 2. Reiping Tang, Hong Hwa Chen, Yung Liang Wang, Chung Rong Changchien, Jinn-Shiun Chen, et 			\footnote{© 2012 Global Journals Inc. (US) © 2012 Global Journals Inc. (US)} 			\footnote{© 2012 Global Journals Inc. (US)} 		 		\backmatter  			  				\begin{bibitemlist}{1}
\bibitem[Biondo et al. (2005)]{b8}\label{b8} 	 		‘Anastomotic dehiscence after resection and primary anastomosis in left-sided colonic emergencies’.  		 			S Biondo 		,  		 			D Parés 		,  		 			E Kreisler 		,  		 			J M Ragué 		,  		 			D Fraccalvieri 		,  		 			A G Ruiz 		,  		 			E Jaurrieta 		.  		 16228841.  	 	 		\textit{Dis Colon Rectum}  		2005 Dec. 48  (12)  p. .  	 
\bibitem[Mohammad U Nasirkhan et al. (2006)]{b13}\label{b13} 	 		‘Anastomotic disruption after large bowel resection’.  		 			Farshad Mohammad U Nasirkhan 		,  		 			Walter Abir 		,  		 			Robert Longo 		,  		 			Kozol 		.  	 	 		\textit{World J Gastroenterol}  		2006 April 28. 12  (16)  p. .  	 
\bibitem[Demetriades et al. (1970)]{b12}\label{b12} 	 		‘Anastomotic failure in relation to blood transfusion and blood loss’.  		 			D Demetriades 		,  		 			J A Murray 		,  		 			L Chan 		,  		 			C Ordoñez 		,  		 			D Bowley 		,  		 			Kk ; G Nagy 		,  		 			B L Greatorex 		,  		 			R A Whitaker 		,  		 			Dixon 		.  		 PMC1811856.  	 	 		\textit{Proc R Soc Med}  		1970 August. 63  (8)  p. 751.  	 	 (Penetrating colon injuries 14) 
\bibitem[Tadros et al. (1992)]{b0}\label{b0} 	 		‘Blood transfusion impairs the healing of experimental intestinal anastomoses’.  		 			T Tadros 		,  		 			Wobbes 		,  		 			Hendriks 		.  	 	 		\textit{Ann Surg}  		1992 March. 215  (3)  p. C1242433.  	 
\bibitem[Alves et al. ()]{b7}\label{b7} 	 		‘Factors associated with clinically significant anastomotic leak after large bowel resection’.  		 			Arnaud Alves 		,  		 			Yves Panis 		,  		 			Danielle Trancart 		,  		 			Jea-Marc Regimbeau 		,  		 			Marc Pocard 		,  		 			Patrice Valleur 		.  		 \xref{http://dx.doi.org/10.1007/s00268-001-0256-4}{10.1007/s00268-001-0256-4}.  	 	 		\textit{World J.Surg}  		2002. 26 p. .  	 
\bibitem[Luján et al. ()]{b6}\label{b6} 	 		‘Factors influencing the outcome of intestinal anasto’.  		 			J J Luján 		,  		 			Z H Németh 		,  		 			P A Barratt-Stopper 		,  		 			R Bustami 		,  		 			V P Koshenkov 		,  		 			R H Rolandelli 		.  		 21944626.  	 	 		\textit{Am Surg}  		2011Sep. 77  (9)  p. .  	 
\bibitem[Ketan and Vagholker ()]{b2}\label{b2} 	 		\textit{Healing of Anastomosis in the Gastrointestinal Tract Retrospective Study of 35 Cases, bhj},  		 			R Ketan 		,  		 			Vagholker 		.  		apr2001. 43.  	 
\bibitem[Stewart et al. (1994)]{b11}\label{b11} 	 		‘Is resection with primary anastomosis following destructive colon wounds always safe?’.  		 			R M Stewart 		,  		 			T C Fabian 		,  		 			M A Croce 		,  		 			F E Pritchard 		,  		 			G Minard 		,  		 			K A Kudsk 		.  	 	 		\textit{Am J Surg}  		1994 Oct. 168  (4)  p. 7943586.  	 
\bibitem[Bennis et al. (2012)]{b9}\label{b9} 	 		‘Morbidity risk factors after low anterior resection with total mesorectal excision and coloanal anastomosis’.  		 			M Bennis 		,  		 			Y Parc 		,  		 			J H Lefevre 		,  		 			N Chafai 		,  		 			E Attal 		,  		 			E Tiret 		.  	 	 		\textit{Ann Surg}  		2012 Mar. 255  (3)  p. .  	 	 (pubmed/22281734) 
\bibitem[Ohwadaa et al. ()]{b5}\label{b5} 	 		‘Morishitaa Effects of Transfusion on Gastrointestinal Anastomotic Wound Healing and Leukocyte Function in Rats’.  		 			S Ohwadaa 		,  		 			Y Satoa 		,  		 			N Satob 		,  		 			Y Toyamac 		,  		 			T Okanoa 		,  		 			Y Nakasonea 		,  		 			T Ogawaa 		,  		 			Y 		.  		 \xref{http://dx.doi.org/10.1159/000052217}{10.1159/000052217}.  	 	 		\textit{Eur Surg Res}  		2000. 32 p. .  	 
\bibitem[Tadros et al. (1993)]{b3}\label{b3} 	 		‘Opposite effects of interleukin-2 on normal and transfusionsuppressed healing of experimental intestinal anastomoses’.  		 			T Tadros 		,  		 			T Wobbes 		,  		 			T Hendriks 		.  	 	 		\textit{Ann Surg}  		1993 Dec. 218  (6)  p. .  	 	 (Pubmed/8257231) 
\bibitem[Apostolidis et al. (2000)]{b4}\label{b4} 	 		‘Prevention of blood-transfusion-induced impairment of anastomotic healing by leucocyte depletion in rats’.  		 			S A Apostolidis 		,  		 			A A Michalopoulos 		,  		 			P M Hytiroglou 		.  	 	 		\textit{Eur J Surg}  		2000 Jul. 166  (7)  p. .  	 	 (Pubmed/10965836) 
\bibitem[Al (2001)]{b1}\label{b1} 	 		\textit{Risk Factors For Surgical Site Infection After Elective Resection of the Colon and Rectum:Ann Surg},  		 			Al 		.  		 PMC1422004.  		2001 August. 234 p. .  	 
\bibitem[Testini et al. ()]{b10}\label{b10} 	 		‘The dehiscence of colorectal anastomoses: the risk factors’.  		 			M Testini 		,  		 			A Margari 		,  		 			M Amoruso 		,  		 			G Lissidini 		,  		 			G M Bonomo 		.  	 	 		\textit{Ann Ital Chir}  		2000.  	 
\end{bibitemlist}
 			 		 	 
\end{document}
