en
Scientific article
English

Relationship between method of anastomosis and anastomotic failure after right hemicolectomy and ileo-caecal resection: an international snapshot audit

Published inColorectal Disease, vol. 19, no. 8, p. e296-e311
Publication date2017
Abstract

Aim: The anastomosis technique used following right- sided colonic resection is widely variable and may affect patient outcome. This study aimed to assess the associa- tion between leak and anastomosis technique (stapled vs handsewn). Method: This was a prospective, multicentre, interna- tional audit including patients undergoing elective or emergency right hemicolectomy or ileo-caecal resection operations over a 2-month period in early 2015. The primary outcome measure was the presence of anasto- motic leak within 30 days of surgery, determined using a prespecified definition. Mixed effects logistic regres- sion models were used to assess the association between leak and anastomosis method, adjusting for patient, dis- ease and operative cofactors, with centre included as a random-effect variable. Results: This study included 3208 patients, of whom 78.4% (n = 2515) underwent surgery for malignancy and 11.7% (n = 375) underwent surgery for Crohn's disease. An anastomosis was performed in 94.8% (n = 3041) of patients, which was handsewn in 38.9% (n = 1183) and stapled in 61.1% (n = 1858). Patients undergoing hand- sewn anastomosis were more likely to be emergency admissions (20.5% handsewn vs 12.9% stapled) and to undergo open surgery (54.7% handsewn vs 36.6% stapled). The overall anastomotic leak rate was 8.1% (245/3041), which was similar following handsewn (7.4%) and stapled (8.5%) techniques (P = 0.3). After adjustment for cofac- tors, the odds of a leak were higher for stapled anastomosis (adjusted OR = 1.43; 95% CI: 1.04–1.95; P = 0.03). Conclusion: Despite being used in lower-risk patients, stapled anastomosis was associated with an increased anastomotic leak rate in this observational study. Fur- ther research is needed to define patient groups in whom a stapled anastomosis is safe.

Keywords
  • Anastomotic leak
  • Colorectal cancer
  • Crohn's disease
  • Epidemiology
  • International
Citation (ISO format)
Relationship between method of anastomosis and anastomotic failure after right hemicolectomy and ileo-caecal resection: an international snapshot audit. In: Colorectal Disease, 2017, vol. 19, n° 8, p. e296–e311. doi: 10.1111/codi.13646
Main files (1)
Article (Published version)
accessLevelPrivate
Identifiers
ISSN of the journal1462-8910
452views
0downloads

Technical informations

Creation10/04/2018 10:01:00 AM
First validation10/04/2018 10:01:00 AM
Update time03/15/2023 1:53:18 PM
Status update03/15/2023 1:53:18 PM
Last indexation01/17/2024 4:12:14 AM
All rights reserved by Archive ouverte UNIGE and the University of GenevaunigeBlack