Relationship between method of anastomosis and anastomotic failure after right hemicolectomy and ileo-caecal resection: an international snapshot audit
Articolo
Data di Pubblicazione:
2017
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 association between leak and anastomosis technique (stapled vs handsewn). Method: This was a prospective, multicentre, international 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 anastomotic leak within 30 days of surgery, determined using a prespecified definition. Mixed effects logistic regression models were used to assess the association between leak and anastomosis method, adjusting for patient, disease 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 handsewn 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 cofactors, 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. Further research is needed to define patient groups in whom a stapled anastomosis is safe.
Tipologia CRIS:
Articolo su Rivista
Keywords:
Anastomotic leak; colorectal cancer; Crohn's disease; epidemiology; international; Gastroenterology
Elenco autori:
Battersby, N.; Bhangu, A.; Chaudhri, S.; El-Hussuna, A.; Frasson, M.; Nepogodiev, D.; Singh, B.; Vennix, S.; Zmora, O.; Altomare, D.; Bemelman, W.; Christensen, P.; D'Hoore, A.; Laurberg, S.; Morton, D.; Rubbini, M.; Vaizey, C.; Magill, L.; Perry, R.; Sheward, N.; Ives, N.; Mehta, S.; Cillo, M.; Estefania, D.; Patron Uriburu, J.; Ruiz, H.; Salomon, M.; Makhmudov, A.; Selnyahina, L.; Varabei, A.; Vizhynis, Y.; Claeys, D.; Defoort, B.; Muysoms, F.; Pletinckx, P.; Vergucht, V.; Debergh, I.; Feryn, T.; Reusens, H.; Nachtergaele, M.; Francart, D.; Jehaes, C.; Markiewicz, S.; Monami, B.; Weerts, J.; Bouckaert, W.; Houben, B.; Knol, J.; Sergeant, G.; Vangertruyden, G.; Haeck, L.; Lange, C.; Sommeling, C.; Vindevoghel, K.; Castro, S.; De Bruyn, H.; De Bruyn, H.; De Bruyn, H.; Huyghe, M.; De Wolf, E.; Reynders, D.; D'Hoore, A.; Wolthuis, A.; Delibegovic, S.; Christiani, A.; Marchiori, M.; de Moraes, C. Rocha; Tercioti, V.; Arabadjieva, E.; Bulanov, D.; Dardanov, D.; Stoyanov, V.; Yonkov, A.; Angelov, K.; Maslyankov, S.; Sokolov, M.; Todorov, G.; Toshev, S.; Georgiev, Y.; Karashmalakov, A.; Zafirov, G.; Wang, X.; Condic, D.; Kraljik, D.; Mrkovic, H.; Pavkovic, V.; Raguž, K.; Bencurik, V.; Holášková, E.; Skrovina, M.; Farkašová, M.; Grolich, T.; Kala, Z.; Antos, F.; Pruchova, V.; Sotona, O.; Chobola, M.; Dusek, T.; Ferko, A.; Örhalmi, J.; Hoch, J.; Kocian, P.; Martinek, L.; Bernstein, I.; Gotschalck Sunesen, K.; Leunbach, J.; Thorlacius-Ussing, O.; Uth Oveson, A.; Christensen, P.; Dahl Chirstensen, S.; Gamez, V.; Oeting, M.; Schou Loeve, U.; Ugianskis, A.; Jessen, M.; Krarup, P.; Linde, K.; Mirza, Q.; Overgaard Stovring, J.; Erritzøe, L.; Loft Jakobsen, H.; Lykke, J.; Palmgren Colov, E.; Husted Madsen, A.; Linde Friis, T.; Amstrup Funder, J.; Dich, R.; Kjær, S.; Rasmussen, S.; Schlesinger, N.; Dilling Kjaer, M.; Qvist, N.; Khalid, A.; Ali, G.; El-Hussuna, A.; Hadi, S.; Rosell Walker, L.; Kivelä, A.; Lehtonen, T.; Lepistö, A.; Scheinin, T.; Siironen, P.; Kössi, J.; Kuusanmäki, P.; Tomminen, T.; Turunen, A.; Rautio, T.; Vierimaa, M.; Huhtinen, H.; Karvonen, J.; Lavonius, M.; Rantala, A.; Varpe, P.; Cotte, E.; Francois, Y.; Glehen, O.; Kepenekian, V.; Passot, G.; Maggiori, L.; Manceau, G.; Panis, Y.; Gout, M.; Rullier, E.; Chafai, N.; Lefevre, J. H.; Parc, Y.; Tiret, E.; Couette, C.; Duchalais, E.; Agha, A.; Hornberger, M.; Hungbauer, A.; Iesalnieks, I.; Weindl, I.; Crescenti, F.; Keller, M.; Kolodziejski, N.; Scherer, R.; Sterzing, D.; Bock, B.; Boehm, G.; El-Magd, M.; Krones, C.; Niewiera, M.; Buhr, J.; Cordesmeyer, S.; Hoffmann, M.; Krückemeier, K.; Vogel, T.; Schön, M.; Baral, J.; Lukoschek, T.; Münch, S.; Pullig, F.; Horisberger, K.; Kienle, P.; Magdeburg, J.; Post, S.; Batzalexis, K.; Germanos, S.; Agalianos, C.; Dervenis, C.; Gouvas, N.; Kanavidis, P.; Kottikias, A.; Katsoulis, I. E.; Korkolis, D.; Plataniotis, G.; Sakorafas, G.; Akrida, I.; Argentou, M.; Kollatos, C.; Lampropoulos, C.; Tsochatzis, S.; Besznyák, I.; Bursics, A.; Egyed, T.; Papp, G.; Svastics, I.; Atladottir, J.; Möller, P.; Sigurdsson, H.; Stefánsson, T.; Valsdottir, E.; Andrews, E.; Foley, N.; Hechtl, D.; Majeed, M.; Mccourt, M.; Hanly, A.; Hyland, J.; Martin, S.; O'Connell, P. R.; Winter, D.; Connelly, T.; Joyce, W.; Wrafter, P.; Berkovitz, R.; Avital, S.; Haj Yahia, I.; Hermann, N.; Shpitz, B.; White, I.; Lishtzinsky, Y.; Tsherniak, A.; Wasserberg, N.; Horesh, N.; Keler, U.; Pery, R.; Shapiro, R.; Zmora, O.; Tulchinsky, H.; Badran, B.; Dayan, K.; Iskhakov, A.; Lecaros, J.; Nabih, N.; Angrima, I.; Bardini, R.; Pizzolato, E.; Tonello, M.; Arces, F.; Balestri, R.; Ceccarelli, C.; Prosperi, V.; Rossi, E.; Giannini, I.; Vincenti, L.; Altomare, D. F.; Di Candido, F.; Di Iena, M.; Guglielmi, A.; Caputi-Iambrenghi, O.; Marsanic, P.; Mellano, A.; Muratore, A.; Annecchiarico, M.; Bencini, L.; Amore Bonapasta, S.; Coratti, A.; Guerra, F.; Asteria, C. R.; Boccia, L.; Gerard, L.; Pascariello, A.; Manca, G.; Marino, F.; Casaril,
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