Influence of multiple stapler firings used for rectal division on colorectal anastomotic leak rate

Tamara Braunschmid, Nikolaus Hartig, Lukas Baumann, Bernhard Dauser, Friedrich Herbst, Tamara Braunschmid, Nikolaus Hartig, Lukas Baumann, Bernhard Dauser, Friedrich Herbst

Abstract

Background: Anastomotic leakage following colorectal resection remains one of the most significant complications with relevant morbidity and mortality. There is evidence that a higher number of stapler firings for rectal division can affect the leak rate in double stapling anastomosis. However, there are no data concerning compression anastomosis. We present our institutional experience addressing this issue.

Design: This is a retrospective review of a prospective institutional database of patients undergoing colonic and rectal resection for benign and malignant indications between January 2008 and December 2014 at the surgical department of the St. John of God Hospital, Vienna. Inclusion criteria were rectal division with linear stapling devices and construction of anastomosis to the rectal stump using a circular stapler or compression device.

Results: Three hundred eighty two (196 female; 51.3%) patients were included. Mean age was 65.8 years (range: 18-95) Indications for the operation included diverticular disease (44.8%), colorectal carcinoma (51.6%), inflammatory bowel disease (1.8%), and adenoma (1.8%). A laparoscopic approach was employed in 334 cases (87.4%); in 170 patients (44.9%), a compression anastomosis was created. One, two, and three or more stapler cartridges were used for rectal division in 58.4, 33.5, and 8.1%, respectively. Male gender, neoadjuvant therapy, rectal cancer as an underlying disease, laparoscopic surgical approach, and duration of operation longer than 200 min are leading causes for the usage of more than one stapler cartridge. Overall leak rate was 4.7% (18/382). The only factor associated with the occurrence of leakage was the use of three or more stapler cartridges for the closure of the rectal stump (p = 0.002).

Conclusion: Our data support that multiple stapler firings for rectal division following colorectal resection has a major impact on anastomotic leak rate. Especially in laparoscopic surgery efforts should be made to minimize the number of stapler cartridges used.

Keywords: Anastomotic leakage; Colorectal diseases; Compression anastomosis; Multiple stapler firings; Rectal division; Stapler anastomosis.

Conflict of interest statement

Drs. Braunschmid, Hartig, Dauser, Herbst, and Mr. Baumann have no conflict of interest or financial ties to disclose.

References

    1. Akiyoshi T, et al. Incidence of and risk factors for anastomotic leakage after laparoscopic anterior resection with intracorporeal rectal transection and double-stapling technique anastomosis for rectal cancer. Am J Surg. 2011;202(3):259–264. doi: 10.1016/j.amjsurg.2010.11.014.
    1. Ito M, et al. Relationship between multiple numbers of stapler firings during rectal division and anastomotic leakage after laparoscopic rectal resection. Int J Colorectal Dis. 2008;23(7):703–707. doi: 10.1007/s00384-008-0470-8.
    1. Kim JS, et al. Risk factors for anastomotic leakage after laparoscopic intracorporeal colorectal anastomosis with a double stapling technique. J Am Coll Surg. 2009;209(6):694–701. doi: 10.1016/j.jamcollsurg.2009.09.021.
    1. Park JS, et al. Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: the Korean laparoscopic colorectal surgery study group. Ann Surg. 2013;257(4):665–771. doi: 10.1097/SLA.0b013e31827b8ed9.
    1. Kawada K, et al. Risk factors for anastomotic leakage after laparoscopic low anterior resection with DST anastomosis. Surg Endosc. 2014;28(10):2988–2995. doi: 10.1007/s00464-014-3564-0.
    1. Kim SH, et al. Laparoscopic resection for rectal cancer: a prospective analysis of thirty-month follow-up outcomes in 312 patients. Surg Endosc. 2006;20(8):1197–1202. doi: 10.1007/s00464-005-0599-2.
    1. Masoomi H, et al. Compression anastomosis ring device in colorectal anastomosis: a review of 1,180 patients. Am J Surg. 2013;205(4):447–451. doi: 10.1016/j.amjsurg.2012.03.013.
    1. Rahbari NN, et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery. 2010;147(3):339–351. doi: 10.1016/j.surg.2009.10.012.
    1. Caulfield H, Hyman NH. Anastomotic leak after low anterior resection: a spectrum of clinical entities. JAMA Surg. 2013;148(2):177–182. doi: 10.1001/jamasurgery.2013.413.
    1. Senn N. Enterorrhaphy; it’s history, technique and present status. JAMA. 1893;21:21.
    1. Mortensen NJ. Intestinal Anastomosis. In: ACS surgery: principles and practice. 5. Gastrointestinal Tract and Abdomen, 2008
    1. Docherty JG, et al. Comparison of manually constructed and stapled anastomoses in colorectal surgery. West of Scotland and Highland Anastomosis Study Group. Ann Surg. 1995;221(2):176–184. doi: 10.1097/00000658-199502000-00008.
    1. Yamamoto S, et al. Risk factors for anastomotic leakage after laparoscopic surgery for rectal cancer using a stapling technique. Surg Laparosc Endosc Percutan Tech. 2012;22(3):239–243. doi: 10.1097/SLE.0b013e31824fbb56.
    1. Makela JT, Kiviniemi H, Laitinen S. Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis. Dis Colon Rectum. 2003;46(5):653–660. doi: 10.1007/s10350-004-6627-9.
    1. Akiyoshi T, et al. Safety of laparoscopic total mesorectal excision for low rectal cancer with preoperative chemoradiation therapy. J Gastrointest Surg. 2009;13(3):521–525. doi: 10.1007/s11605-008-0744-z.
    1. Scheidbach H, et al. Laparoscopic abdominoperineal resection and anterior resection with curative intent for carcinoma of the rectum. Surg Endosc. 2002;16(1):7–13. doi: 10.1007/s00464-001-8314-4.
    1. Yeh CY, et al. Pelvic drainage and other risk factors for leakage after elective anterior resection in rectal cancer patients: a prospective study of 978 patients. Ann Surg. 2005;241(1):9–13.
    1. Dauser B, et al. Anastomotic leakage after low anterior resection for rectal cancer: comparison of stapled versus compression anastomosis. Langenbecks Arch Surg. 2013;398(7):957–964. doi: 10.1007/s00423-013-1103-4.
    1. WHO. Obesity and overweight—Fact sheet N311. . Accessed Aug 2014
    1. Seidell JC, Flegal KM. Assessing obesity: classification and epidemiology. Br Med Bull. 1997;53(2):238–252. doi: 10.1093/oxfordjournals.bmb.a011611.
    1. D’Hoore A, et al. COMPRES: a prospective postmarketing evaluation of the compression anastomosis ring CAR 27()/ColonRing() Colorectal Dis. 2015;17(6):522–529. doi: 10.1111/codi.12884.
    1. Matthiessen P, et al. Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis. 2004;6(6):462–469. doi: 10.1111/j.1463-1318.2004.00657.x.
    1. Levack M, et al. Laparoscopy decreases anastomotic leak rate in sigmoid colectomy for diverticulitis. Arch Surg. 2011;146(2):207–210. doi: 10.1001/archsurg.2010.325.
    1. Matthiessen P, et al. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg. 2007;246(2):207–214. doi: 10.1097/SLA.0b013e3180603024.
    1. Dulucq JL, et al. Laparoscopic rectal resection with anal sphincter preservation for rectal cancer: long-term outcome. Surg Endosc. 2005;19(11):1468–1474. doi: 10.1007/s00464-005-0081-1.
    1. Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy) Surg Laparosc Endosc. 1991;1(3):144–150.
    1. Feliciotti F, et al. Long-term results of laparoscopic versus open resections for rectal cancer for 124 unselected patients. Surg Endosc. 2003;17(10):1530–1535. doi: 10.1007/s00464-002-8874-y.
    1. Zhang FW, et al. Laparoscopic versus open surgery for rectal cancer: a systematic review and meta-analysis of randomized controlled trials. Asian Pac J Cancer Prev. 2014;15(22):9985–9996. doi: 10.7314/APJCP.2014.15.22.9985.
    1. Leroy J, et al. Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes. Surg Endosc. 2004;18(2):281–289. doi: 10.1007/s00464-002-8877-8.
    1. Nussbaum DP, et al. Laparoscopic versus open low anterior resection for rectal cancer: results from the national cancer data base. J Gastrointest Surg. 2015;19(1):124–131. doi: 10.1007/s11605-014-2614-1.
    1. Zhou ZG, et al. Laparoscopic versus open total mesorectal excision with anal sphincter preservation for low rectal cancer. Surg Endosc. 2004;18(8):1211–1215. doi: 10.1007/s00464-003-9170-1.
    1. Lacy AM, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet. 2002;359(9325):2224–2229. doi: 10.1016/S0140-6736(02)09290-5.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться