Clinical impact of leakage in patients with handsewn vs stapled anastomosis after right hemicolectomy: a retrospective study

Abstract

Aim Anastomotic leakage is a major complication after right hemicolectomy leading to increased morbidity, mortality, length of stay and hospital costs. Previous studies have shown that the type of anastomosis (handsewn or stapled) is a major risk factor for anastomotic leakage. The purpose of this study was to evaluate the clinical impact of anastomotic leakage depending on the type of anastomotic technique (handsewn vs stapled). Method This was an observational, retrospective, crosssectional study. Data were collected at two major hospitals in Spain from January 2010 to December 2016. Patients had elective right colectomy for cancer with handsewn or stapled ileocolic anastomosis. The main outcome was the grading of postoperative treatments needed to manage anastomotic leakage according to two major classification systems. The other outcomes were demographics, time of hospitalization and death rate. Results Patients (n = 961) underwent elective surgery for neoplasia of the right colon. Anastomotic leakage was diagnosed in 116 patients (12.07%). Patients with handsewn anastomosis had more Type IIIA surgical complications and received milder treatments than patients with stapled anastomosis (SA) who had more Type IIIB complications and more re-laparotomies (P = 0.004). The clinical impact of anastomotic leakage was significantly more severe (Grade C) in patients with SA than in patients with a handsewn anastomosis (P = 0.007). No differences were found for hospital stay of patients with anastomotic leakage depending on the type of anastomosis (P = 0.275). Death due to anastomotic leakage was similar in both groups. Conclusions The clinical impact of anastomotic leakage in patients with handsewn anastomosis is lower than in patients with SA.

C-reactive protein level on postoperative day 3 as a predictor of anastomotic leakage after elective right-sided colectomy

“…In the current study, the frequency of anastomotic leakage was higher in patients who underwent stapled end-to-end anastomosis than in those with handsewn or stapled sideto-end anastomosis. One previous report found that stapled anastomosis was associated with a significantly lower frequency of anastomotic leakage than handsewn anastomoses [18]; however, several recent reports on ileocolic anastomosis have identified a higher anastomotic leakage rate for stapled vs handsewn anastomoses [5,6,10,11,13]. Lee et al compared side-to-side and end-to-side anastomosis approaches in laparoscopic right hemicolectomy [14].…”

“…Anastomotic leakage is associated with mortality, short-and long-term morbidity, a potentially increased risk of recurrence, and poor prognosis [1,2]. The anastomotic leakage rate after right-sided colectomy is reported to range from 1.7 to 12% [3][4][5][6][7][8][9][10][11][12][13].…”

Robotic right hemicolectomy and partial nephrectomy for synchronous malignancies – a video vignette

“…Dear Editor, Oncological outcomes of laparoscopic resections for T4 colon cancer have not shown any significant difference between comparative observational studies and open surgery, although the risk of developing postoperative complications was significantly lower with a minimally invasive approach [1,2]. However, some multivisceral resections may be technically challenging.…”

Outcomes of Intra- versus Extra-Corporeal Ileocolic Anastomosis after Minimally Invasive Right Colectomy for Cancer: An Observational Study

“…Several risk factors have been identified for AL, including age, preoperative nutritional status, or laparoscopic approach [ 14 ]. Stapled anastomosis has been reported to present higher rates of clinically relevant AL [ 14 , 15 ], but without increasing either mortality or length of stay (LOS).…”