Risk factors for ileocolic anastomosis dehiscence; a cohort study

Lazzara, Claudio; Zerpa, Carla; Sobrino, Lucía; Fico, Valeria; Kreisler, Esther; Biondo, Sebastiano

doi:10.1016/j.amjsurg.2019.11.020

Cited by 20 publications

(16 citation statements)

References 38 publications

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“…Surgical techniques and technologies as well as perioperative care have greatly evolved over the past several decades; however, further research will be required to understand the aetiology of AL and to identify those patients at higher risk. Recent investigations are directed to increasing the knowledge of AL from different points of view, from technical aspects to basic research: suture reinforcement [22], indocyanine green [28] or the role of gut microbiota as a possible influence in the risk for AL. New methods to make safer anastomoses or how the lesions could disrupt the local environment and lead to recurrence remain to be elucidated [29].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Discussionmentioning

confidence: 99%

“…The importance of the suture reinforcement has been proved recently by Golda et al . [22] in a retrospective study of 470 ileocolic anastomoses where this reinforcement resulted as an independent protective factor ( P < 0.001).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…Although an important difference is not observed comparing the anastomotic leakage rate between ECA and ICA, some authors advocated that leakage after ICA is related to higher clinical impact due to the severity of dehiscence in comparison to ECA. 6 – 22 This could be related, even if not demonstrated, to the fact that the mechanical anastomosis is performed by a single layer suture in comparison to most of the manual anastomosis performed by a double layer suture, 23 , 24 as in the present series. Espin et al reported an analysis of 116 patients who experienced anastomotic leakage after right hemicolectomy.…”

Section: Discussionmentioning

confidence: 62%

Extracorporeal Hand-Sewn vs. Intracorporeal Mechanic Anastomosis During Laparoscopic Right Colectomy

Lepiane

Balla

Licardie

et al. 2022

JSLS

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Background and Objectives: To compare the outcomes of extracorporeal hand-sewn side-to-side isoperistaltic ileocolic anastomosis (EHSIA) versus intracorporeal mechanic side-to-side isoperistaltic ileocolic anastomosis (IMSIA) during laparoscopic right hemicolectomy for adenocarcinoma. Methods: This is a retrospective propensity score-matched analysis of prospectively collected data. Fifty-four patients who underwent surgery with EHSIA (intervention group) were paired with 54 patients who underwent surgery with IMSIA (control group) based on patients’ demographics and type of surgery (standard right hemicolectomy or extended right hemicolectomy). Results: Fifty-four patients were included for each group. Statistically significant differences between groups were not observed in patients’ demographics and type of surgery. Conversion occurred in three patients of the intervention group due to intra-abdominal adhesions for previous surgery (5.6%) (p = 0.079). Median operative time was statistically significant shorter in the control group in comparison to the intervention group (85 and 117.5 minutes, respectively, p ≤ 0.0001). In both groups one anastomotic leakage was observed (1.9%) (Clavien-Dindo grade III-a). In the control group one patient (1.9%) underwent reintervention for acute postoperative anemia (Clavien-Dindo grade III-b). Median number of harvested lymph-nodes was 17 and 12 (p ≤ 0.0001), in the intervention and the control group, respectively. Median hospital stay was statistically significant lower in the control group in comparison to the intervention group (5 and 6.5 days, respectively, p ≤ 0.013). Conclusion: IMSIA showed lower operative time and hospital stay in comparison to EHSIA. Further randomized studies are required to draw definitive conclusions about the best anastomotic technique during laparoscopic right hemicolectomy.

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“…Although various anastomotic methods have been described, such as end-to-end, end-to-side, or side-to-side configurations with stapled or handsewn junctions, the most ideal method is still disputed. Handsewn end-to-end anastomosis is a standard procedure for reconstructing intestinal continuity, but it presents problems such as stenosis and diameter discrepancy, especially for ileocolic anastomosis and prolonging operative time [ 11 , 12 ]. After the introduction of stapling devices, mechanical anastomosis became popular worldwide because of its convenience and stability.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the short-term outcomes between intracorporeal isoperistaltic and antiperistaltic totally stapled side-to-side anastomosis for right colectomy: A retrospective study on 214 consecutive patients

Zhang

et al. 2022

Surgery Open Science

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Risk factors for ileocolic anastomosis dehiscence; a cohort study

Cited by 20 publications

References 38 publications

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

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

Extracorporeal Hand-Sewn vs. Intracorporeal Mechanic Anastomosis During Laparoscopic Right Colectomy

Comparison of the short-term outcomes between intracorporeal isoperistaltic and antiperistaltic totally stapled side-to-side anastomosis for right colectomy: A retrospective study on 214 consecutive patients

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