Prospective study of hand-sutured anastomosis after colorectal resection

Mann, B.; Kleinschmidt, S.; Stremmel, Wolfgang

doi:10.1002/bjs.1800830108

Cited by 69 publications

(52 citation statements)

References 21 publications

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“…Mann et al, Surgery: colorectal resection Definition: as below 1996, 276 (n = 370) Germany Clinical features: anastomotic leak was suspected if the patient showed Aim: to prospectively evaluate the fever, leucocytosis, persistent ileus, bleeding or discharge, or any other sign safety and efficacy of hand-sutured of intra-abdominal or pelvic abscess anastomosis in unselected patients in a district hospital Investigations: routine contrast enema was not performed. In patients with the above clinical features, a water-soluble contrast enema was carried out immediately Mansour, Surgery: oesophagectomy (n = 131) Definition: none et al, 1997, 215 …”

Section: Medline and Healthstarmentioning

confidence: 99%

The measurement and monitoring of surgical adverse events

Bruce

Russell

Mollison

et al. 2001

Health Technol Assess

296

209

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Section: Medline and Healthstarmentioning

confidence: 99%

The measurement and monitoring of surgical adverse events

Bruce

Russell

Mollison

et al. 2001

Health Technol Assess

296

209

View full text Add to dashboard Cite

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“…The rate of AL after anterior resection (AR) varies from 3% to 19% [4][5][6][7][8][9][10][11], being clinically significant in 2.9-15.3% of patients. Mortality following a leak may be 6.0-39.3% [12].…”

Section: Introductionmentioning

confidence: 99%

Anastomotic leaks after anterior resection for mid and low rectal cancer: survey of the Italian Society of Colorectal Surgery

Asteria

Gagliardi²,

Pucciarelli³

et al. 2008

Tech Coloproctol

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univariate and multivariate analyses. Further analysis was conducted on patients with AL to identify factors correlated with gravity. Results There were 520 patients representing 64% of LAR for rectal cancer performed by SICCR members. The overall rate of AL was 15.2%. Mortality was 2.7% including 0.6% from AL. The incidence of AL was correlated with higher age (p<0.05), lower (<20 per year) centre case volume (p<0.05), obesity (p<0.05), malnutrition (p<0.01) and intraoperative contamination (p<0.05), and was lower in patients with a colonic J-pouch reservoir (p<0.05). In the multivariate analysis age, malnutrition and intraoperative contamination were independent predictors. The only predictor of severe (grade III/IV) AL was alcohol/smoking habits (p<0.05) while the absence of a diverting stoma was borderline significant (p<0.07). Conclusions Our retrospective survey identified several risk factors for AL. This survey was a necessary step to construct prospective interventional studies and to establish benchmark standards for outcome studies. Keywords Anastomotic leaks · Low anterior resection · Rectal cancer · Outcome studies IntroductionAnastomotic leakage (AL) is the most significant surgical complication following resection for rectal cancer [1], affecting perioperative mortality and possibly longterm survival [2,3]. The rate of AL after anterior resection (AR) varies from 3% to 19% [4][5][6][7][8][9][10][11], being clinically significant in 2.9-15.3% of patients. Mortality following a leak may be 6.0-39.3% [12]. Most of the reports of complications after surgery for colorectal cancer come Abstract Background The aim of the survey was to assess the incidence of anastomotic leaks (AL) and to identify risk factors predicting incidence and gravity of AL after low anterior resection (LAR) for rectal cancer performed by colorectal surgeons of the Italian Society of Colorectal Surgery (SICCR). Methods Information about patients with rectal cancers less than 12 cm from the anal verge who underwent LAR during 2005 was collected retrospectively. AL was classified as grade I to IV according to gravity. Fifteen clinical variables were examined by ing factors predicting the gravity of AL among patients with AL this classification was simplified to mild to moderate (grades 1 and 2) and severe (grades 3 and 4).Categorical variables were evaluated using either Fisher's exact test or Pearson's chi-squared test depending on sample size. Numerical variables were evaluated using Student's t-test. P values <0.05 were considered significant. All variables which were associated with the incidence or gravity of AL in the univariate analysis were entered into a multivariate logistic regression model. Data were analysed using the STATA program (release 8.0, 2003; Stata Corporation, College Station, TX). ResultsOf 108 centres contacted, 44 (40.7%) participated. Information on 682 patients with rectal cancer who had undergone surgery was collected. Sphincter-saving surgery was performed in 579 patients (84.9%). After excluding abdom...

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“…In our own study we detected six leakages (8%), three (4%) of which required reintervention. Concerning hand-sutured rectum anastomoses the reported leakage rate ranges from 0 to 20%, depending on the suture technique [21, 22, 23]. Comparative studies show a leakage rate of 0–12% after stapling and 3–27% after hand suture [24, 25].…”

Section: Discussionmentioning

confidence: 99%

Long-Term Results after 75 Anastomoses in the Upper Extraperitoneal Rectum with the Biofragmentable Anastomosis Ring

Debus

Sailer²,

Geiger³

et al. 1999

Dig Surg

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Background: Anastomoses in the rectum have a higher risk for complications compared with other gastrointestinal regions. Stapling devices and sophisticated developments in surgical suture materials did not lead to a substantial decrease of local complications. The bioabsorbable anastomosis ring (BAR) is a new alternative technique for creating gastrointestinal anastomoses. Accordingly, the aim of this prospective study was to evaluate the postoperative course and long-term results of patients after anterior rectum resection using BAR. Methods: From 1991 to 1996 75 BAR anastomoses were performed in the upper rectum at the Department of Surgery, University Hospital Würzburg. Thirty-eight patients suffered from malignant, 37 from benign disease. Mean age was 61.4 years with no relevant differences in the gender. Mean follow-up was 31 months (4–63 months). The clinical course was evaluated, a questionnaire completed and/or a 3-monthly reevaluation with endoscopy conducted. Mortality, anastomostic bleeding, leakage and development of anastomotic stenosis were evaluated. Results: Sixty-seven patients could be reexamined. There was no postoperative mortality and no anastomotic bleeding. Six patients (8%) developed an anastomotic leakage, of whom 3 (4%) required reoperation. None of the patients revealed a detectable stenosis in the anastomotic region during follow-up. Conclusion: The BAR procedure is a safe and suitable anastomotic technique after anterior rectum resection.

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Prospective study of hand-sutured anastomosis after colorectal resection

Cited by 69 publications

References 21 publications

The measurement and monitoring of surgical adverse events

The measurement and monitoring of surgical adverse events

Anastomotic leaks after anterior resection for mid and low rectal cancer: survey of the Italian Society of Colorectal Surgery

Long-Term Results after 75 Anastomoses in the Upper Extraperitoneal Rectum with the Biofragmentable Anastomosis Ring

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