The impact of stapling technique and surgeon specialism on anastomotic failure after right-sided colorectal resection: an international multicentre, prospective audit

TY - JOUR

T1 - The impact of stapling technique and surgeon specialism on anastomotic failure after right-sided colorectal resection

T2 - an international multicentre, prospective audit

AU - Glasbey, J. C.

AU - Nepogodiev, D.

AU - Battersby, N.

AU - Bhangu, A.

AU - El-Hussuna, A.

AU - Frasson, M.

AU - Singh, B.

AU - Vennix, S.

AU - Jessen, M.

AU - Lykke, J.

AU - Kjær, S.

AU - Rasmussen, S.

AU - El-Hussuna, A.

AU - Hadi, S.

AU - Keller, M.

AU - Hoffmann, M.

AU - Münch, S.

AU - Post, S.

AU - Möller, P.

AU - Winter, D.

AU - Hermann, N.

AU - Casaril, A.

AU - De Luca, M.

AU - Romano, F.

AU - Silva, P.

AU - Costa, S.

AU - Pereira, C.

AU - Sousa, M.

AU - Popovic, M.

AU - Folkesson, J.

AU - Frey, J.

AU - Gustafsson, D.

AU - Meyer, J.

AU - Hoffmann, H.

AU - French, J.

AU - Johnson, M.

AU - Bell, A.

AU - Robertson, A.

AU - Arnold, S.

AU - Malik, A. I.

AU - Malik, A. I.

AU - Miller, A.

AU - Aslam, M.

AU - Evans, J.

AU - Akhtar, M.

AU - Ahmed, J.

AU - Sharma, A.

AU - Hussain, A.

AU - Khan, A.

AU - Perrin, K.

AU - the 2015 European Society of Coloproctology Collaborating Group

PY - 2018

Y1 - 2018

N2 - Aim: 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. Method: 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: One thousand three hundred and forty-seven 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 with a noncutting stapler (8.4% vs 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% vs 9.7%, OR 0.87, 95% CI 0.52–1.46, P = 0.60) or noncutting group (8.9% vs 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% vs 7.3%, OR 1.65, 95% CI 1.04–2.64, P = 0.04). Conclusion: 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 for general surgeons which remained after risk adjustment needs further exploration.

AB - Aim: 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. Method: 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: One thousand three hundred and forty-seven 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 with a noncutting stapler (8.4% vs 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% vs 9.7%, OR 0.87, 95% CI 0.52–1.46, P = 0.60) or noncutting group (8.9% vs 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% vs 7.3%, OR 1.65, 95% CI 1.04–2.64, P = 0.04). Conclusion: 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 for general surgeons which remained after risk adjustment needs further exploration.

KW - anastomotic leak

KW - Bowel anastomosis

KW - colorectal cancer

KW - Crohn's disease

KW - epidemiology

KW - international

KW - oversewn

KW - stapler

KW - surgery

KW - surgical technique

U2 - 10.1111/codi.14308

DO - 10.1111/codi.14308

M3 - Journal article

C2 - 29920945

AN - SCOPUS:85050459075

SN - 1462-8910

VL - 20

SP - 1028

EP - 1040

JO - Colorectal Disease

JF - Colorectal Disease

IS - 11

ER -