Side-to-side stapled anastomosis strongly reduces anastomotic leak rates in Crohn's disease surgery.
ABSTRACT Anastomotic configuration may influence anastomotic leak rates. The aim of this study was to determine whether a side-to-side stapled ileocolonic anastomosis produces lower anastomotic leak rates than those with a handsewn end-to-end ileocolonic anastomosis after ileocecal or ileocolonic resection for Crohn's disease.
A series of 122 consecutive patients underwent elective ileocecal or ileocolonic resection with ileocolonic anastomosis for Crohn's disease from January 1998 to June 2003: 71 had handsewn end-to-end anastomosis and 51 had side-to-side stapled anastomosis. The choice between the two anastomoses was left to the surgeon's preference. A retrospective analysis was performed to assess if there was any difference in anastomotic leak rates.
The two groups were comparable in terms of age, gender, preoperative presence of abscess or fistula, history of smoking, and albumin levels. More patients were taking steroids in the handsewn group than in the stapled group. In the handsewn group there were 10 anastomotic leaks (14.1 percent) and in the stapled group there was 1 anastomotic leak (2.0 percent) (risk difference, +12.1 percent; 95 percent confidence interval, 1.7-22.2; P = 0.02). Anastomotic configuration was the sole variable that influenced anastomotic leak rates at univariate analysis. Mortality was 1.4 percent in the handsewn group and 0 percent in the stapled group. Complications other than anastomotic leak developed in 11 patients in the hand-sewn group and in 6 patients in the stapled group. Mean postoperative hospital stay was 12.3 days in the handsewn group and 9.7 days in the stapled group (P = 0.03). Excluding those patients who had an anastomotic leak, the difference was still present (handsewn group, 10.1 days; stapled group, 9.1 days; P = 0.04).
Although confirmation from randomized, controlled trials is required, side-to-side stapled anastomosis seems to substantially decrease anastomotic leak rates in surgical patients with Crohn's disease, compared with handsewn end-to-end anastomosis. Postoperative hospital stay decreased in the stapled anastomosis group, and this was not entirely a result of decreased anastomotic leak rates.
SourceAvailable from: PubMed Central[Show abstract] [Hide abstract]
ABSTRACT: The purpose of this study was to compare short-term clinical outcomes of ileocolonic functional end-to-end anastomosis (FEEA) and end-to-side anastomosis (ESA) following resection of the right colon for cancer.World Journal of Surgical Oncology 10/2014; 12(1):306. DOI:10.1186/1477-7819-12-306 · 1.20 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Background: The use of mechanical anastomoses reduce the length of gastrointestinal surgical procedures. Aim: To report the experience with mechanical functional terminal anastomoses in bowel surgery. Material and Methods: Prospective non randomized registry of all mechanical anastomoses carried out in a surgical service. Results: A total of 327 patients (193 women) were analyzed. Two hundred and one anastomoses were ileo-colonic and 126 were entero-enteral. Seventeen percent of patients experienced some complication. Fourteen required a new operation due to peritonitis or deep infection of the surgical site. The global rate of anastomotic dehiscence was 3.1%. No differences in the rate of complications between surgeons with experience and trainees were observed. Conclusions: Mechanical anastomoses in bowel surgery are safe and require a short learning period to be used.06/2012; 64(3):274-277. DOI:10.4067/S0718-40262012000300009
[Show abstract] [Hide abstract]
ABSTRACT: The objective of this study was to identify clinical leak in diverted colorectal anastomoses. Cohort analysis. The study was conducted in a subspecialty practice at a tertiary care facility. Consecutive subjects undergoing colorectal anastomosis and proximal fecal diversion between July 16, 2007 and June, 31 2012. No intervention was applied. Clinical anastomotic leak. Two hundred forty-five patients underwent a colorectal anastomosis with proximal fecal diversion. A total of 34 (14 %) clinical leaks were identified at a median of 43 days. Clinical leaks were identified in 13 (5 %) patients within 30 days of surgery (early leaks) and in 21 (9 %) patients after 30 days of surgery (late leaks). Age, sex, use of neoadjuvant chemoradiotherapy, and method of anastomotic construction were similar in patients with clinical leaks as compared to those with no evidence of leak. However, clinical leaks were more likely to develop in patients with a diagnosis of inflammatory bowel disease or other diagnoses, i.e., radiation enteritis, ischemia, and injury/enterotomy. Patients with clinical leak were not more likely to have air leaks on intraoperative air leak testing. In diverted anastomoses, most leaks become clinically apparent beyond 30 days. The standard practice of censoring outcomes that occur beyond postoperative day 30 will fail to identify a substantial fraction of leaks in diverted colorectal anastomoses.Journal of Gastrointestinal Surgery 07/2014; 18(10). DOI:10.1007/s11605-014-2588-z · 2.39 Impact Factor