Naslov
Does laparoscopic low anterior resections have higher rate of anastomotic dehiscencence?

Autori
Stipančić, Igor ; Knežević, Mario ; Baković, Josip ; Kolak, Toni ; Runjić, Ivana ; Kliček, Robert ; Miočinović, Milan ;

Izvornik
Surgical endoscopy (0930-2795) 28 (2014); S116-S116

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, abstract, stručni

Ključne riječi
laparoscopy ; rectal cancer ; surgery ; anastomotic leak

Sažetak
Aims: Anastomotic leak is one of the most serious complications of colorectal surgery and may result in inadequate functional and oncological outcomes. The aim of this study is to assess the incidence and outcomes of clinical anastomotic leak in patients submitted to laparoscopic and open colorectal resections performed by single surgeon. Methods: All colorectal resections with primary anastomosis (n=180) performed between 2005. and 2012. were prospectively entered into database. Results: Of 180 resections 92 pts was done by laparoscopic and 88 by open approach. In 87 pts anastomosis was hand-made and in 93 created by stapler. The most common procedures were low anterior resection (n=61, open/lap 34/27), left and sigmoid resection (n=60, open/lap 29/31) and right colectomy (n=52, open/lap 27/25). Overall anastomotic leak rate was 5.0 %. Anastomotic leak mortality rate was 11.1% (1/9). In univariate analysis, the following parameters were associated with an increased risk for anastomotic leak: (1) ASA score≥3 (p=0.05), (2) prolonged (>3 h) operative time (p=0.03), (3) rectal location of the disease (p<0.001). There was no difference in overall clinical anastomotic leak between laparoscopic (5.43%) and open procedures (4.54%). All cases of clinical anastomotic leak (n=9) occurred after low anterior resections: after low colorectal in 6 and after coloanal anastomosis in 3 patients. Low anterior resection was performed in 61 patients: in 27 by laparoscopic and in 34 by open approach. Rate of clinical anastomotic leak after low anterior resections was 14.75% (9 of 61). Leaks occurred in 18.51% (5 of 27) after laparoscopic and in 11.76% (4 of 34) low or ultra-low anterior resections. Eight patients required reoperation with two needing the anastomosis take down and 6 patients had the anastomosis defunctioned by loop ileostomy without taking down primary anastomosis. Conclusion: In our series anastomotic leak occurred only after low and ultra-low anterior resections. Our data have raised concern that laparoscopic rectal resections are associated with increased risk of anastomotic leakage suggesting that we need more experience and better technical support in this type of surgery.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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