Background: Anastomotic leakage remains one of the most critical complications following gastrointestinal surgical procedures, often resulting in significant morbidity and mortality. Multiple variables—preoperative, intraoperative, and postoperative—can influence the risk of such leaks.

Objective: To identify and analyze potential risk factors contributing to anastomotic leakage in bowel surgeries.

Methods: This prospective study included 60 patients who underwent bowel resection with anastomosis at Gauhati Medical College and Hospital between March 1, 2021, and June 30, 2022.

Results: Out of 60 patients, 15 (25%) developed an anastomotic leak, while 45 (75%) did not. Significant factors associated with leaks included male gender, lower preoperative serum albumin (mean: 2.9 g/dL, p = 0.01), emergency surgical procedures, intraoperative hypotension, and higher units of blood transfusion.

Conclusion: Key contributors to anastomotic leakage in this cohort were male gender, hypoalbuminemia (≤2.9 g/dL), intraoperative hypotension, and blood transfusion requirements. These variables should be critically assessed when planning bowel anastomosis to minimize complications.