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.
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- "Strictures at sites of prior anastomoses may be secondary to recurrent disease or technical problems from the first surgery. To prevent this, there is some evidence that stapled side-to-side anastomosis in patients who have Crohn's disease have a decreased rate of postoperative strictures and leaks    . In a study including 72 ileocolic and 7 colocolic resection and anastomoses , only 2% of those patients who underwent stapled side-to-side anastomosis developed recurrent symptoms at 46 months, versus 43% of those undergoing hand-sewn end-to-end repair . "
ABSTRACT: Evaluation and management of the patient who has Crohn's disease of the colon, rectum, and anus is challenging for even the most experienced provider. Because of its broad spectrum of presentation, recurrent nature, and potential for high morbidity, the surgeon needs to not only treat the acute situation but also keep in mind the potential long-term ramifications. Although there are exciting new medications and treatment modalities yielding promising results, surgery continues to remain at the forefront for the care of these patients. This article reviews various surgical options for the patient who has Crohn's disease of the colon, rectum, and perianal region with emphasis on symptomatic resolution and optimization of function.Surgical Clinics of North America 07/2007; 87(3):611-31. DOI:10.1016/j.suc.2007.03.006 · 1.93 Impact Factor
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ABSTRACT: Strictureplasty leak in patients with Crohn's disease increases considerably morbidity rate. Intra-operative evaluation of the integrity of suture line and proficient management of any leakage after strictureplasty is mandatory to prevent post-operative complications. When a leakage is detected at the posterior side, through intra-operative insufflation or methylene blue test, it may be difficult to repair as the suture line is completely covered up by mesentery. The AA. describe the creation of a mesenteric window to reinforce the posterior side of a side-to-side stapled strictureplasty performed by laparoscopic assisted procedure. As far as we know, this new technical strategy may allow avoiding resection of small bowel.Annali italiani di chirurgia 77(3):259-62. · 0.68 Impact Factor