Analysis of the impact of EEA stapler size on risk of anastomotic complications in colorectal anastomosis: does size matter?

Paula, Thais Reif de; Simon, Hillary L.; Shah, Mansi; Lee-Kong, Steven A.; Kiely, James M.; Kiran, Ravi P.; Keller, Deborah S.

doi:10.1007/s10151-020-02155-3

Cited by 12 publications

(22 citation statements)

References 21 publications

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“…In prior large series, when strictures were identified based on the existence of symptoms alone, anastomotic stricture rates were reported in the range of 5-10%. [1][2][3][4][5]9 Among studies which examined anastomoses endoscopically, there is variability in the size of scope used and therefore how strictures were defined. [1][2][3][4][5]8,10 Authors have previously demonstrated that there is no clear correlation between degree of stricture and clinical symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5]9 Among studies which examined anastomoses endoscopically, there is variability in the size of scope used and therefore how strictures were defined. [1][2][3][4][5]8,10 Authors have previously demonstrated that there is no clear correlation between degree of stricture and clinical symptoms. 1 Using the 12 mm cutoff, we sought to limit the number of patients subjected to unnecessary dilatations, assuming that mild strictures would be more likely to resolve over time and could be managed with adequate bowel regimens.…”

Section: Discussionmentioning

confidence: 99%

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Risk Factors Associated with the Development of Colorectal Anastomotic Strictures Prior to Diverting Loop Ileostomy Reversal

Sandilos

Zhu

Giugliano

et al. 2022

The American Surgeon™

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Background Anastomotic strictures represent a major source of morbidity in colorectal surgery with an incidence reported up to 30%. Despite this, the mechanism by which strictures develop remains unclear. This study aims to determine the incidence of colorectal anastomotic strictures and associated risk factors among a series of diverted patients. Materials and Methods A retrospective chart review was conducted of 142 patients over a 7-year period at a single institution after colorectal resection with anastomosis and diverting ileostomy creation re-examined with postoperative endoscopy. One patient was removed due to anastomotic tumor recurrence. Patient and technical factors were examined for significance using chi-square analysis. Logistic regression was used to perform multivariate analysis to estimate odds ratio (OR) and 95% confidence intervals (CI). Results Among 141 patients, 14.1% (20 patients) developed strictures detected on endoscopy. Strictures were observed in a greater percentage of women than men (21.2% vs 8%, P = .025). 30.6% of patients who underwent resections for diverticulitis developed strictures while those with neoplastic lesions and other indications had stricture rates of 6.8% and 17.6%, respectively ( P = .002). Anastomoses performed during a colostomy reversal were associated with a higher stricture rate (OR 4.23, 95% CI 1.37-13.40, P = .012). Anastomoses performed with a 28/29 mm EEA circular stapler demonstrated a significantly higher stricture rate versus a 31/33 mm stapler (OR 7.21, 95% CI 1.23-155.58, P = .045). Discussion Our data reveal that female sex, history of diverticulitis, anastomoses performed in the setting of colostomy reversal, and smaller stapler size are associated with a higher rate of anastomotic stricture.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk Factors Associated with the Development of Colorectal Anastomotic Strictures Prior to Diverting Loop Ileostomy Reversal

Sandilos

Zhu

Giugliano

et al. 2022

The American Surgeon™

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“…It has been found that mechanical anastomoses are associated with higher levels of collagen deposition and more inflammation, which may lead to stricture formation. [ 21 ] Besides, surgeons can control the caliber and shape of anastomoses better when they are using the hand-sewn method. [ 22 ] The bleomycin group had the longer reintervention interval and less treatment times than dilation group.…”

Section: Discussionmentioning

confidence: 99%

Clinical efficacy of endoscopic dilation combined with bleomycin injection for benign anastomotic stricture after rectal surgery

et al. 2022

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Benign anastomotic stricture is a frequent complication after rectal surgery. This study investigated the feasibility of endoscopic dilation combined with bleomycin injection for benign anastomotic stricture after rectal surgery. 31 patients who diagnosed with benign anastomotic stricture after rectal surgery were included in this study. 15 patients received simple endoscopic dilation (dilation group) and 16 patients received endoscopic dilation combined with bleomycin injection (bleomycin group). The clinical effect and adverse events were compared in the 2 groups. The strictures were managed successfully and the obstruction symptoms were relieved immediately. There were 2 minor complications in dilation group and 3 minor complications in bleomycin group. The difference was not significant between the 2 groups (P > .05). During the follow-up, the mean reintervention interval was 4.97 ± 1.00 months in dilation group and 7.60 ± 1.36 months in bleomycin group. The median treatment times was 4 (range 3–5) in dilation group and 2 (range 2–3) in bleomycin group. The differences in the 2 groups were significant (P < .05). Compared with endoscopic dilation, endoscopic dilation combined with bleomycin injection may reduce the treatment times and prolong the reintervention interval, which is a safe and effective endoscopic management for benign anastomotic stricture after rectal surgery.

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“…Typical examples are stapler sizes. One study showed that 25-29 mm EEA staplers were associated with an increased rate of AS compared with 30-33 mm staplers [31]. In contrast, another showed that using 25 mm circular staplers is safe and does not increase the risk of AS compared with larger staplers [17].…”

Section: Discussionmentioning

confidence: 99%

Definition and grading of anastomotic stricture/stenosis following low anastomosis after total mesorectal excision: A single-center study

Cong

Zhang

Chen

2022

Preprint

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BACKGROUND: Anastomotic stricture/stenosis is an alarming complication after colorectal surgery, and there is still no recognized definition for anastomotic stricture/stenosis. This study aimed to determine the status and change of anastomotic stricture/stenosis after rectal surgery using a special anastomotic stricture/stenosis definition and grading system, discuss various risk factors for anastomotic stricture/stenosis, and explore the effect of different degrees of anastomotic stricture/stenosis on bowel function. METHODS: This study included patients with confirmed rectal cancer who underwent total mesorectal excision between May 2014 and May 2021. A five-degree special anastomotic stricture/stenosis definition and grading system was used to determine anastomotic stricture/stenosis status, and clinical outcomes and risk factors for anastomotic stricture/stenosis were investigated. Furthermore, the low anterior resection syndrome score was used to assess bowel function. RESULTS: A total of 473 patients were enrolled in this study. The low anterior resection syndrome assessment showed that the more severe the anastomotic stricture/stenosis, the more severe the low anterior resection syndrome (all p<0.001). Univariate and multivariate analyses of patient-related and technical risk factors for anastomotic stricture/stenosis were performed 3 months postoperatively. For univariate analysis, female sex was a lower risk factor for anastomotic stricture/stenosis. Defunctioning stoma, neoadjuvant chemoradiotherapy, chemotherapy, and anastomotic leakage were higher risk factors for anastomotic stricture/stenosis (all p<0.05). For multivariate analysis, only neoadjuvant chemoradiotherapy, chemotherapy, and anastomotic leakage were still higher risk factors for anastomotic stricture/stenosis (all p<0.05). CONCLUSIONS: Through a special anastomotic stricture/stenosis definition and grading system’s evaluation, we noted the anastomotic stricture/stenosis severity significantly affected bowel function, and multivariate analysis showed that neoadjuvant chemoradiotherapy, chemotherapy, and anastomotic leakage were the higher risk factors for anastomotic stricture/stenosis.

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Analysis of the impact of EEA stapler size on risk of anastomotic complications in colorectal anastomosis: does size matter?

Cited by 12 publications

References 21 publications

Risk Factors Associated with the Development of Colorectal Anastomotic Strictures Prior to Diverting Loop Ileostomy Reversal

Risk Factors Associated with the Development of Colorectal Anastomotic Strictures Prior to Diverting Loop Ileostomy Reversal

Clinical efficacy of endoscopic dilation combined with bleomycin injection for benign anastomotic stricture after rectal surgery

Definition and grading of anastomotic stricture/stenosis following low anastomosis after total mesorectal excision: A single-center study

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