Common side closure type, but not stapler brand or oversewing, influences side-to-side anastomotic leak rates

• Published in: The American journal of surgery Vol. 213; no. 3; pp. 590 - 595
• Main Authors: Fleetwood, V.A, Gross, K.N, Alex, G.C, Cortina, C.S, Smolevitz, J.B, Sarvepalli, S, Bakhsh, S.R, Poirier, J, Myers, J.A, Singer, M.A, Orkin, B.A
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2017; Elsevier Limited
• Subjects: Adolescent; Adult; Age; Aged; Aged, 80 and over; Anastomosis, Surgical - methods; Anastomotic leak; Anastomotic Leak - etiology; Brand; Cost control; Demographics; Device; Diabetes Mellitus - epidemiology; Equipment Design; Female; Humans; Intestines - surgery; Logistics; Male; Middle Aged; Multivariate Analysis; Operative Time; Oversewing; Patients; Retrospective Studies; Risk Factors; Side to side anastomosis; Stapler; Studies; Surgeons; Surgery; Surgical Stapling - instrumentation; Surgical Stapling - methods; Variables; Young Adult; Brand; Side to side anastomosis; Stapler; Anastomotic leak; Device; Oversewing
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2016.10.038

Abstract Background Anastomotic leak (AL) increases costs and cancer recurrence. Studies show decreased AL with side-to-side stapled anastomosis (SSA), but none identify risk factors within SSAs. We hypothesized that stapler characteristics and closure technique of the common enterotomy affect AL rates. Methods Retrospective review of bowel SSAs was performed. Data included stapler brand, staple line oversewing, and closure method (handsewn, HC; linear stapler [Barcelona technique], BT; transverse stapler, TX). Primary endpoint was AL. Statistical analysis included Fisher's test and logistic regression. Results 463 patients were identified, 58.5% BT, 21.2% HC, and 20.3% TX. Covidien staplers comprised 74.9%, Ethicon 18.1%. There were no differences between stapler types (Covidien 5.8%, Ethicon 6.0%). However, AL rates varied by common side closure (BT 3.7% vs. TX 10.6%, p = 0.017), remaining significant on multivariate analysis. Conclusion Closure method of the common side impacts AL rates. Barcelona technique has fewer leaks than transverse stapled closure. Further prospective evaluation is recommended.