Naslov
The impact of stapling technique and surgeon specialism on anastomotic failure after right- sided colorectal resection: An international multi-centre, prospective audit

Autori
Glasbey, JC ; Nepogodiev, D ; Battersby, N ; Bhangu, A ; El- Hussuna, A ; Frasson, M ; Singh, B ; Vennix, S ; Zmora, O ; Pinkney, T ; Chaudhri, S ; Bemelman, W ; Christensen, P ; D'Hoore A ; Laurberg, S ; Morton, D ; Pinkney, T ; Rubbini, M ; Vaizey, C ; Mehta, S ; Ives, N ; Magill, L ; Perry, R ; Sheward, N ; … ; Čondić, Dunja ; Kraljik, Darko ; Mrković, Hrvoje ; Pavković, Vjekoslav ; Raguž, Krešimir et al.

Kolaboracija
2015 European Society of Coloproctology Collaborating Group

Izvornik
Colorectal disease (1462-8910) 20 (2018), 11; 1028-1040

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, članak, znanstveni

Ključne riječi
Crohn's disease ; anastomotic leak ; bowel anastomosis ; colorectal cancer ; epidemiology ; international ; oversewn ; stapler ; surgery ; surgical technique

Sažetak
BACKGROUND: There is little evidence to support choice of technique and configuration for stapled anastomoses after right hemicolectomy and ileocaecal resection. This study aimed to determine the relationship between stapling technique and anastomotic failure. METHODS: Any unit performing gastrointestinal surgery was invited to contribute data on consecutive adult patients undergoing right hemicolectomy or ileocolic resection to this prospective, observational, international, multicentre study. Patients undergoing stapled, side-to-side ileocolic anastomoses were identified and multilevel, multivariable logistic regression analyses were performed to explore factors associated with anastomotic leak. RESULTS: 1347 patients were included from 200 centres in 32 countries. The overall anastomotic leak rate was 8.3%. Upon multivariate analysis, there was no difference in leak rate with use of a cutting stapler for apical closure compared to non-cutting stapler (8.4% versus 8.0%, OR:0.91, 95% CI:0.54- 1.53, P=0.72). Oversewing of the apical staple line, whether in the cutting group (7.9% versus 9.7%, OR:0.87, 95% CI:0.52-1.46, P=0.60), or non- cutting group (8.9% versus 5.7%, OR:1.40, 95% CI:0.46-4.23, P=0.55) also conferred no benefit in terms of reducing leak rates. Surgeons reporting to be General Surgeons had a significantly higher leak rate than those reporting to be Colorectal Surgeons (12.1% versus 7.3%, OR:1.65, 95% CI:1.04- 2.64, P=0.04). DISCUSSION: This study did not identify any difference in anastomotic leak rates according to the type of stapling device used to close the apical aspect. In addition, oversewing of the anastomotic staple lines appears to confer no benefit in terms of reducing leak rates. Although General Surgeons operated on patients with more high-risk characteristics than Colorectal Surgeons, a higher leak rate in General Surgeons which remained after risk adjustment needs further exploration.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA