Abstract

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.

Original languageEnglish
Pages (from-to)1028-1040
Number of pages13
JournalColorectal Disease
Volume20
Issue number11
DOIs
Publication statusPublished - Nov 1 2018

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Anastomotic Leak
Risk Adjustment
Patient Rights
Multicenter Studies
Surgeons
Multivariate Analysis
Logistic Models
Regression Analysis
Equipment and Supplies

Keywords

  • anastomotic leak
  • Bowel anastomosis
  • colorectal cancer
  • Crohn's disease
  • epidemiology
  • international
  • oversewn
  • stapler
  • surgery
  • surgical technique

ASJC Scopus subject areas

  • Gastroenterology

Cite this

The impact of stapling technique and surgeon specialism on anastomotic failure after right-sided colorectal resection : an international multicentre, prospective audit. / the 2015 European Society of Coloproctology Collaborating Group.

In: Colorectal Disease, Vol. 20, No. 11, 01.11.2018, p. 1028-1040.

Research output: Contribution to journalArticle

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title = "The impact of stapling technique and surgeon specialism on anastomotic failure after right-sided colorectal resection: an international multicentre, prospective audit",
abstract = "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.",
keywords = "anastomotic leak, Bowel anastomosis, colorectal cancer, Crohn's disease, epidemiology, international, oversewn, stapler, surgery, surgical technique",
author = "{the 2015 European Society of Coloproctology Collaborating Group} and Glasbey, {J. C.} and D. Nepogodiev and N. Battersby and A. Bhangu and A. El-Hussuna and M. Frasson and B. Singh and S. Vennix and O. Zmora and T. Pinkney and S. Chaudhri and W. Bemelman and P. Christensen and A. D'Hoore and S. Laurberg and D. Morton and T. Pinkney and M. Rubbini and C. Vaizey and S. Mehta and M. Tonello and E. Rossi and P. Marsanic and A. Mellano and A. Muratore and F. Marino and M. Carvello and M. Montorsi and A. Spinelli and S. Scabini and A. Belli and F. Bianco and {De Franciscis}, S. and P. Delrio and U. Pace and D. Rega and C. Sassaroli and D. Scala and {De Luca}, R. and E. Ruggieri and F. Mariani and S. Caruso and R. Rosati and {De Luca}, M. and Ferrari, {C. C.} and F. Romano and S. Costa and M. Sacchetti and L. Ventura and M. P{\'e}rez",
year = "2018",
month = "11",
day = "1",
doi = "10.1111/codi.14308",
language = "English",
volume = "20",
pages = "1028--1040",
journal = "Colorectal Disease",
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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 - the 2015 European Society of Coloproctology Collaborating Group

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 - Zmora, O.

AU - Pinkney, T.

AU - Chaudhri, S.

AU - Bemelman, W.

AU - Christensen, P.

AU - D'Hoore, A.

AU - Laurberg, S.

AU - Morton, D.

AU - Pinkney, T.

AU - Rubbini, M.

AU - Vaizey, C.

AU - Mehta, S.

AU - Tonello, M.

AU - Rossi, E.

AU - Marsanic, P.

AU - Mellano, A.

AU - Muratore, A.

AU - Marino, F.

AU - Carvello, M.

AU - Montorsi, M.

AU - Spinelli, A.

AU - Scabini, S.

AU - Belli, A.

AU - Bianco, F.

AU - De Franciscis, S.

AU - Delrio, P.

AU - Pace, U.

AU - Rega, D.

AU - Sassaroli, C.

AU - Scala, D.

AU - De Luca, R.

AU - Ruggieri, E.

AU - Mariani, F.

AU - Caruso, S.

AU - Rosati, R.

AU - De Luca, M.

AU - Ferrari, C. C.

AU - Romano, F.

AU - Costa, S.

AU - Sacchetti, M.

AU - Ventura, L.

AU - Pérez, M.

PY - 2018/11/1

Y1 - 2018/11/1

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

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U2 - 10.1111/codi.14308

DO - 10.1111/codi.14308

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C2 - 29920945

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SP - 1028

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JO - Colorectal Disease

JF - Colorectal Disease

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