1. The impact of stapling technique and surgeon specialism on anastomotic failure after right-sided colorectal resection: an international multicentre, prospective audit
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Glasbey, Jc, Nepogodiev, D, Battersby, N, Bhangu, A, El-Hussuna, A, Frasson, M, Singh, B, Vennix, S, Zmora, O, Pinkney, T, Chaudhri, S, Bemelman, W, Christensen, P, D'Hoore, A, Laurberg, S, Morton, D, Rubbini, M, Vaizey, C, Mehta, S, Ives, N, Magill, L, Perry, R, Sheward, N, Cillo, M, Estefania, D, Patron Uriburu, J, Ruiz, H, Salomon, M, Makhmudov, A, Selnyahina, L, Varabei, A, Vizhynis, Y, Claeys, D, Defoort, B, Muysoms, F, Pletinckx, P, Vergucht, V, Debergh, I, Feryn, T, Reusens, H, Nachtergaele, M, Francart, D, Jehaes, C, Markiewicz, S, Monami, B, Weerts, J, Bouckaert, W, Houben, B, Knol, J, Sergeant, G, Vangertruyden, G, Haeck, L, Lange, C, Sommeling, C, Vindevoghel, K, Castro, S, De Bruyn, H, Huyghe, M, De Wolf, E, Reynders, D, de Buck van Overstraeten, A, Wolthuis, A, Delibegovic, S, Christiani, A, Marchiori, M Jr, Rocha de Moraes, C, Tercioti, V Jr, Arabadjieva, E, Bulanov, D, Dardanov, D, Stoyanov, V, Yonkov, A, Angelov, K, Maslyankov, S, Sokolov, M, Todorov, G, Toshev, S, Georgiev, Y, Karashmalakov, A, Zafirov, G, Wang, X, Condic, D, Kraljik, D, Mrkovic, H, Pavkovic, V, Raguž, K, Bencurik, V, Holášková, E, Skrovina, M, Farkašová, M, Grolich, T, Kala, Z, Antos, F, Pruchova, V, Sotona, O, Chobola, M, Dusek, T, Ferko, A, Örhalmi, J, Hoch, J, Kocian, P, Martinek, L, Bernstein, I, Gotschalck Sunesen, K, Leunbach, J, Thorlacius-Ussing, O, Uth Oveson, A, Dahl Chirstensen, S, Gamez, V, Oeting, M, Schou Loeve, U, Ugianskis, A, Jessen, M, Krarup, P, Linde, K, Mirza, Q, Overgaard Stovring, J, Erritzøe, L, Loft Jakobsen, H, Lykke, J, Palmgren Colov, E, Husted Madsen, A, Linde Friis, T, Amstrup Funder, J, Dich, R, Kjaer, S, Rasmussen, S, Schlesinger, N, Dilling Kjaer, M, Qvist, N, Khalid, A, Ali, G, Hadi, S, Rosell Walker, L, Kivelä, A, Lehtonen, T, Lepistö, A, Scheinin, T, Siironen, P, Kössi, J, Kuusanmäki, P, Tomminen, T, Turunen, A, Rautio, T, Vierimaa, M, Huhtinen, H, Karvonen, J, Lavonius, M, Rantala, A, Varpe, P, Cotte, E, Francois, Y, Glehen, O, Kepenekian, V, Passot, G, Maggiori, L, Manceau, G, Panis, Y, Gout, M, Rullier, E, van Geluwe, B, Chafai, N, Lefevre, Jh, Parc, Y, Tiret, E, Couette, C, Duchalais, E, Agha, A, Hornberger, M, Hungbauer, A, Iesalnieks, I, Weindl, I, Crescenti, F, Keller, M, Kolodziejski, N, Scherer, R, Sterzing, D, Bock, B, Boehm, G, El-Magd, M, Krones, C, Niewiera, M, Buhr, J, Cordesmeyer, S, Hoffmann, M, Krückemeier, K, Vogel, T, Schön, M, Baral, J, Lukoschek, T, Münch, S, Pullig, F, Horisberger, K, Kienle, P, Magdeburg, J, Post, S, Batzalexis, K, Germanos, S, Agalianos, C, Dervenis, C, Gouvas, N, Kanavidis, P, Kottikias, A, Katsoulis, Ie, Korkolis, D, Plataniotis, G, Sakorafas, G, Akrida, I, Argentou, M, Kollatos, C, Lampropoulos, C, Tsochatzis, S, Besznyák, I, Bursics, A, Egyed, T, Papp, G, Svastics, I, Atladottir, J, Möller, P, Sigurdsson, H, Stefánsson, T, Valsdottir, E, Andrews, E, Foley, N, Hechtl, D, Majeed, M, Mccourt, M, Hanly, A, Hyland, J, Martin, S, O'Connell, Pr, Winter, D, Connelly, T, Joyce, W, Wrafter, P, Berkovitz, R, Avital, S, Haj Yahia, I, Hermann, N, Shpitz, B, White, I, Lishtzinsky, Y, Tsherniak, A, Wasserberg, N, Horesh, N, Keler, U, Pery, R, Shapiro, R, Tulchinsky, H, Badran, B, Dayan, K, Iskhakov, A, Lecaros, J, Nabih, N, Angrima, I, Bardini, R, Pizzolato, E, Tonello, M, Arces, F, Balestri, R, Ceccarelli, C, Prosperi, V, Rossi, E, Giannini, I, Vincenti, L, Di Candido, F, Di Iena, M, Guglielmi, A, Caputi-Iambrenghi, O, Marsanic, P, Mellano, A, Muratore, A, Annecchiarico, M, Bencini, L, Amore Bonapasta, S, Coratti, A, Guerra, F, Asteria, Cr, Boccia, L, Gerard, L, Pascariello, A, Manca, G, Marino, F, Casaril, A, Inama, M, Moretto, G, Bacchelli, C, Carvello, M, Mariani, N, Montorsi, M, Spinelli, A, Romairone, E, Scabini, S, Belli, A, Bianco, F, De Franciscis, S, Maria Romano, G, Delrio, P, Pace, U, Rega, D, Sassaroli, C, Scala, D, De Luca, R, Ruggieri, E, Elbetti, C, Garzi, A, Romoli, L, Scatizzi, M, Vannucchi, A, Curletti, G, Durante, V, Galleano, R, Mariani, F, Reggiani, L, Bellomo, R, Infantino, A, Franceschilli, L, Sileri, P, Clementi, I, Coletta, D, La Torre, F, Mingoli, A, Velluti, F, Di Giacomo, A, Fiorot, A, Massani, M, Padoan, L, Ruffolo, C, Caruso, S, Franceschini, F, Laessig, R, Monaci, I, Rontini, M, Annunziata Azienda SM, De Nardi, P, Elmore, U, Lemma, M, Rosati, R, Tamburini, A, De Luca, M, Sartori, A, Benevento, A, Bottini, C, Ferrari, Cc, Pata, F, Tessera, G, Pellino, G, Selvaggi, F, Lanzani, A, Romano, F, Sgroi, G, Steccanella, F, Turati, L, Yamamoto, T, Ancans, G, Gerkis, S, Leja, M, Pcolkins, A, Sivins, A, Latkauskas, T, Lizdenis, P, Saladžinskas, Ž, Švagždys, S, Tamelis, A, Razbadauskas, A, Sokolovas, M, Dulskas, A, Samalavicius, N, Jotautas, V, Mikalauskas, S, Poskus, E, Poskus, T, Strupas, K, Camenzuli, C, Cini, C, Predrag, A, Psaila, J, Spiteri, N, Buskens, C, de Groof EJ, Gooszen, J, Tanis, P, Belgers, E, Davids, P, Furnee, E, Postma, E, Pronk, A, Smakman, N, Clermonts, S, Zimmerman, D, Omloo, J, van der Zaag, E, van Duijvendijk, P, Wassenaar, E, Bruijninckx, M, de Graff, E, Doornebosch, P, Tetteroo, G, Vermaas, M, Iordens, G, Knops, S, Toorenvliet, B, van Westereenen HL, Boerma, E, Coene, P, van der Harst, E, Van Der Pool, A, Raber, M, Melenhorst, J, de Castro, S, Gerhards, M, Arron, M, Bremers, A, de Wilt, H, Ferenschild, F, Yauw, S, Cense, H, Demirkiran, A, Hunfeld, M, Mulder, I, Nonner, J, Swank, H, van Wagensveld, B, Bolmers, M, Briel, J, van Geloven, A, van Rossem, C, Klemann, V, Konsten, J, Leenders, B, Schok, T, Bleeker, W, Gidwani, A, Lawther, R, Loughlin, P, Skelly, B, Spence, R, Brun, M, Helgeland, M, Ignjatovic, D, Øresland, T, Yousefi, P, Flåten Backe, I, Helmer Sjo, O, Nesbakken, A, Tandberg-Eriksen, M, Cais, A, Hallvard Traeland, J, Herikstad, R, Kørner, H, Lauvland, N, Jajtner, D, Kabiesz, W, Rak, M, Gmerek, L, Horbacka, K, Horst, N, Krokowicz, P, Kwiatkowski, A, Pasnik, K, Karcz, P, Romaniszyn, M, Rusek, T, Walega, P, Czarencki, R, Obuszko, Z, Sitarska, M, Wojciech, W, Zawadzki, M, 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C., Nepogodiev, D., Battersby, N., Bhangu, A., El-Hussuna, A., Frasson, M., Singh, B., Vennix, S., Zmora, O., Pinkney, T., Chaudhri, S., Bemelman, W., Christensen, P., D'Hoore, A., Laurberg, S., Morton, D., Rubbini, M., Vaizey, C., Mehta, S., Ives, N., Magill, L., Perry, R., Sheward, N., Cillo, M., Estefania, D., Patron Uriburu, J., Ruiz, H., Salomon, M., Makhmudov, A., Selnyahina, L., Varabei, A., Vizhynis, Y., Claeys, D., Defoort, B., Muysoms, F., Pletinckx, P., Vergucht, V., Debergh, I., Feryn, T., Reusens, H., Nachtergaele, M., Francart, D., Jehaes, C., Markiewicz, S., Monami, B., Weerts, J., Bouckaert, W., Houben, B., Knol, J., Sergeant, G., Vangertruyden, G., Haeck, L., Lange, C., Sommeling, C., Vindevoghel, K., Castro, S., De Bruyn, H., Huyghe, M., De Wolf, E., Reynders, D., de Buck van Overstraeten, A., Wolthuis, A., Delibegovic, S., Christiani, A., Marchiori, M., Rocha de Moraes, C., Tercioti, V., Arabadjieva, E., Bulanov, D., Dardanov, D., Stoyanov, V., Yonkov, A., Angelov, K., Maslyankov, S., Sokolov, M., Todorov, G., Toshev, S., Georgiev, Y., Karashmalakov, A., Zafirov, G., Wang, X., Condic, D., Kraljik, D., Mrkovic, H., Pavkovic, V., Raguž, K., Bencurik, V., Holášková, E., Skrovina, M., Farkašová, M., Grolich, T., Kala, Z., Antos, F., Pruchova, V., Sotona, O., Chobola, M., Dusek, T., Ferko, A., Örhalmi, J., Hoch, J., Kocian, P., Martinek, L., Bernstein, I., Gotschalck Sunesen, K., Leunbach, J., Thorlacius-Ussing, O., Uth Oveson, A., Dahl Chirstensen, S., Gamez, V., Oeting, M., Schou Loeve, U., Ugianskis, A., Jessen, M., Krarup, P., Linde, K., Mirza, Q., Overgaard Stovring, J., Erritzøe, L., Loft Jakobsen, H., Lykke, J., Palmgren Colov, E., Husted Madsen, A., Linde Friis, T., Kjær, S., Rasmussen, S., Schlesinger, N., Dilling Kjaer, M., Qvist, N., Khalid, A., Ali, G., Hadi, S., Rosell Walker, L., Kivelä, A., Lehtonen, T., Lepistö, A., Scheinin, T., Siironen, P., Kössi, J., Kuusanmäki, P., Tomminen, T., Turunen, A., Rautio, T., Vierimaa, M., Huhtinen, H., Karvonen, J., Lavonius, M., Rantala, A., Varpe, P., Cotte, E., Francois, Y., Glehen, O., Kepenekian, V., Passot, G., Maggiori, L., Manceau, G., Panis, Y., Gout, M., Rullier, E., van Geluwe, B., Chafai, N., Lefevre, J. H., Parc, Y., Tiret, E., Couette, C., Duchalais, E., Agha, A., Hornberger, M., Hungbauer, A., Iesalnieks, I., Weindl, I., Crescenti, F., Keller, M., Kolodziejski, N., Scherer, R., Sterzing, D., Bock, B., Boehm, G., El-Magd, M., Krones, C., Niewiera, M., Buhr, J., Cordesmeyer, S., Hoffmann, M., Krückemeier, K., Vogel, T., Schön, M., Baral, J., Lukoschek, T., Münch, S., Pullig, F., Horisberger, K., Kienle, P., Magdeburg, J., Post, S., Batzalexis, K., Germanos, S., Agalianos, C., Dervenis, C., Gouvas, N., Kanavidis, P., Kottikias, A., Katsoulis, I. E., Korkolis, D., Plataniotis, G., Sakorafas, G., Akrida, I., Argentou, M., Kollatos, C., Lampropoulos, C., Tsochatzis, S., Besznyák, I., Bursics, A., Egyed, T., Papp, G., Svastics, I., Atladottir, J., Möller, P., Sigurdsson, H., Stefánsson, T., Valsdottir, E., Andrews, E., Foley, N., Hechtl, D., Majeed, M., Mccourt, M., Hanly, A., Hyland, J., Martin, S., O'Connell, P. 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J., Gallardo Herrera, A. B., Diaz López, C., Navarro Rodriguez, E., Torres Tordera, E., Arenal, J., Citores, M., Marcos, J., Sánchez, J., Tinoco, C., Espin, E., Garcia Granero, A., Jimenez Gomez, L., Sanchez Garcia, J., Vallribera, F., Folkesson, J., Sköldberg, F., Bergman, K., Borgström, E., Frey, J., Silfverberg, A., Söderholm, M., Nygren, J., Segelman, J., Gustafsson, D., Lagerqvist, A., Papp, A., Pelczar, M., Abraham-Nordling, M., Ahlberg, M., Sjovall, A., Tengstrom, J., Hagman, K., Chabok, A., Ezra, E., Nikberg, M., Smedh, K., Tiselius, C., Al-Naimi, N., Dao Duc, M., Meyer, J., Mormont, M., Ris, F., Prevost, G., Villiger, P., Hoffmann, H., Kettelhack, C., Kirchhoff, P., Oertli, D., Weixler, B., Aytac, B., Leventoglu, S., Mentes, B., Yuksel, O., Demirbas, S., Busra Ozkan, B., Selçuk Özbalci, G., Sungurtekin, U., Gülcü, B., Ozturk, E., Yilmazlar, T., Challand, C., Fearnhead, N., Hubbard, R., Kumar, S., Arthur, J., Barben, C., Skaife, P., Slawik, S., Williams, M., Zammit, M., Barker, J., French, J., Sarantitis, I., Slawinski, C., Clifford, R., Eardley, N., Johnson, M., Mcfaul, C., Vimalachandran, D., Allan, S., Bell, A., Oates, E., Shanmugam, V., Brigic, A., Halls, M., Pucher, P., Stubbs, B., Agarwal, T., Chopada, A., Mallappa, S., Pathmarajah, M., Sugden, C., Brown, C., Macdonald, E., Mckay, A., Richards, J., Robertson, A., Kaushal, M., Patel, P., Tezas, S., Touqan, N., Ayaani, S., Marimuthu, K., Piramanayagam, B., Vourvachis, M., Iqbal, N., Korsgen, S., Seretis, C., Shariff, U., Arnold, S., Chan, H., Clark, E., Fernandes, R., Moran, B., Bajwa, A., Mcarthur, D., Cao, K., Cunha, P., Pardoe, H., Quddus, A., Theodoropoulou, K., Bolln, C., Denys, G., Gillespie, M., Manimaran, N., Reidy, J., Malik, A. I., Malik, A., Pitt, J., Aryal, K., El-Hadi, A., Lal, R., Pal, A., Velchuru, V., Oliveira Cunha, M., Thomas, M., Bains, S., Boyle, K., Miller, A., Norwood, M., Yeung, J., Goian, L., Gurjar, S., Saghir, W., Sengupta, N., Stewart-Parker, E., Bailey, S., Khalil, T., Lawes, D., Nikolaou, S., Omar, G., Church, R., Muthiah, B., Garrett, W., Marsh, P., Obeid, N., Chandler, S., Coyne, P., Evans, M., Hunt, L., Lim, J., Oliphant, Z., Papworth, E., Weaver, H., Cuiñas Leon, K., Williams, G., Hernon, J., Kapur, S., Moosvi, R., Shaikh, I., Swafe, L., Aslam, M., Evans, J., Ihedioha, U., Kang, P., Merchant, J., Hompes, R., Middleton, R., Broomfield, A., Crutten-Wood, D., Foster, J., Nash, G., Akhtar, M., Boshnaq, M., Eldesouky, S., Mangam, S., Rabie, M., Ahmed, J., Khan, J., Ming Goh, N., Shamali, A., Stefan, S., Thompson, C., Amin, A., Docherty, J., Lim, M., Walker, K., Watson, A., Hossack, M., Mackenzie, N., Paraoan, M., Alam, N., Daniels, I., Narang, S., Pathak, S., Smart, N., Al-Qaddo, A., Codd, R., Rutka, O., Bronder, C., Crighton, I., Davies, E., Raymond, T., Bookless, L., Griffiths, B., Plusa, S., Carlson, G., Harrison, R., Lees, N., Mason, C., Quayle, J., Branagan, G., Broadhurst, J., Chave, H., Sleight, S., Awad, F., Cruickshank, N., Joy, H., Boereboom, C., Daliya, P., Dhillon, A., Watson, N., Watson, R., Artioukh, D., Gokul, K., Javed, M., Kong, R., Sutton, J., Faiz, O., Jenkins, I., Leo, C. A., Samaranayake, S. F., Warusavitarne, J., Arya, S., Bhan, C., Mukhtar, H., Oshowo, A., Wilson, J., Duff, S., Fatayer, T., Mbuvi, J., Sharma, A., Cornish, J., Davies, L., Harries, R., Morris, C., Torkington, J., Knight, J., Lai, C., Shihab, O., Tzivanakis, A., Hussain, A., Luke, D., Padwick, R., Torrance, A., Tsiamis, A., Dawson, P., Balfour, A., Brady, R., Mander, J., Paterson, H., Chandratreya, N., Chu, H., Cutting, J., Vernon, S., Wai Ho, C., Andreani, S., Patel, H., Warner, M., Yan Qi Tan, J., Iqbal, A., Khan, A., Perrin, K., Raza, A., Tan, S., Meyer, Jérémy, Graduate School, TOBB ETÜ, Tıp Fakültesi, Cerrahi Tıp Bilimleri Bölümü, TOBB ETU, Faculty of Medicine, Department of Surgical Sciences, and Demirbaş, Sezai
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Crohn’s disease ,Male ,Leak ,Surgi-cal technique ,anastomotic leak ,Bowel anastomosis ,colorectal cancer ,Crohn's disease ,epidemiology ,international ,oversewn ,stapler ,surgery ,surgical technique ,Colorectal cancer ,medicine.medical_treatment ,030230 surgery ,Colon/surgery ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,0302 clinical medicine ,Epidemiology ,Prospective Studies ,Treatment Failure ,Young adult ,Prospective cohort study ,Colectomy ,Aged, 80 and over ,General Surgery/statistics & numerical data ,Medical Audit ,ddc:617 ,Anastomosis, Surgical ,Gastroenterology ,Middle Aged ,Colorectal Neoplasms/surgery ,Colorectal surgery ,030220 oncology & carcinogenesis ,Female ,Colectomy/adverse effects ,Colorectal Neoplasms ,Anastomotic Leak/etiology ,Adult ,medicine.medical_specialty ,Adolescent ,Colon ,bowel anastomosis ,Colorectal Surgery/statistics & numerical data ,Anastomosis ,NO ,Young Adult ,03 medical and health sciences ,Surgical Stapling ,medicine ,Humans ,Aged ,ta3126 ,business.industry ,Anastomosis, Surgical/adverse effects ,Surgical Stapling/adverse effects ,Bowel anastomosi ,medicine.disease ,Surgery ,Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10] ,General Surgery ,business ,Colorectal Surgery - Abstract
AIM: There is little evidence to support choice of technique and configuration for stapled anastomoses after right hemicolectomy and ileocaecal resection. This study aimed to determine the relationship between stapling technique and anastomotic failure.METHOD: Any unit performing gastrointestinal surgery was invited to contribute data on consecutive adult patients undergoing right hemicolectomy or ileocolic resection to this prospective, observational, international, multicentre study. Patients undergoing stapled, side-to-side ileocolic anastomoses were identified and multilevel, multivariable logistic regression analyses were performed to explore factors associated with anastomotic leak.RESULTS: One thousand three hundred and forty-seven patients were included from 200 centres in 32 countries. The overall anastomotic leak rate was 8.3%. Upon multivariate analysis there was no difference in leak rate with use of a cutting stapler for apical closure compared with a noncutting stapler (8.4% vs 8.0%, OR 0.91, 95% CI 0.54-1.53, P = 0.72). Oversewing of the apical staple line, whether in the cutting group (7.9% vs 9.7%, OR 0.87, 95% CI 0.52-1.46, P = 0.60) or noncutting group (8.9% vs 5.7%, OR 1.40, 95% CI 0.46-4.23, P = 0.55) also conferred no benefit in terms of reducing leak rates. Surgeons reporting to be general surgeons had a significantly higher leak rate than those reporting to be colorectal surgeons (12.1% vs 7.3%, OR 1.65, 95% CI 1.04-2.64, P = 0.04).CONCLUSION: This study did not identify any difference in anastomotic leak rates according to the type of stapling device used to close the apical aspect. In addition, oversewing of the anastomotic staple lines appears to confer no benefit in terms of reducing leak rates. Although general surgeons operated on patients with more high-risk characteristics than colorectal surgeons, a higher leak rate for general surgeons which remained after risk adjustment needs further exploration.
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- 2018
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