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Tytuł:
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Renewed assessment of the stapled anastomosis with the increasing role of laparoscopic colectomy for colon cancer.
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Autorzy:
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Amri R; Division of General and Gastrointestinal Surgery, Massachusetts General Hospital & Harvard Medical School, 15 Parkman Street, Boston, MA, 02114, USA.
Bordeianou LG
Sylla P
Berger DL
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Źródło:
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Surgical endoscopy [Surg Endosc] 2015 Sep; Vol. 29 (9), pp. 2675-82. Date of Electronic Publication: 2014 Dec 04.
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Typ publikacji:
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Comparative Study; Journal Article; Research Support, N.I.H., Extramural
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Język:
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English
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Imprint Name(s):
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Publication: 1992- : New York : Springer
Original Publication: [Berlin] : Springer International, c1987-
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MeSH Terms:
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Laparoscopy*
Surgical Stapling*
Sutures*
Anastomosis, Surgical/*methods
Colectomy/*methods
Colonic Neoplasms/*surgery
Anastomotic Leak/etiology ; Humans ; Operative Time
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References:
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JAMA Surg. 2013 Feb;148(2):190-201. (PMID: 23426599)
Dis Colon Rectum. 1998 Feb;41(2):180-9. (PMID: 9556242)
Br J Surg. 1991 Nov;78(11):1297-300. (PMID: 1760685)
Br J Surg. 1985 Aug;72(8):603-5. (PMID: 3896372)
Cochrane Database Syst Rev. 2012 Feb 15;(2):CD003144. (PMID: 22336786)
Ann Surg. 1995 Feb;221(2):176-84. (PMID: 7857145)
Am J Surg. 1984 May;147(5):629-32. (PMID: 6202161)
World J Gastrointest Surg. 2012 Sep 27;4(9):208-13. (PMID: 23293735)
Surgery. 1994 Sep;116(3):484-90. (PMID: 8079178)
Acta Chir Scand. 1986 Feb;152:157-60. (PMID: 3953213)
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Grant Information:
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8UL1TR000170-05 United States TR NCATS NIH HHS
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Entry Date(s):
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Date Created: 20141205 Date Completed: 20160520 Latest Revision: 20181202
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Update Code:
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20240104
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DOI:
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10.1007/s00464-014-3989-5
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PMID:
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25472748
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Introduction: Stapled gastrointestinal anastomosis has gained wide adoption among the surgical community for its ease, speed, and its applicability in laparoscopic surgery. Over the last decade, with the increase in laparoscopic techniques in colon surgery, anastomotic stapling has become the technique of choice for colon cancer surgery at our center. This abstract assesses whether the increasing adoption of anastomotic stapling affected the rate of anastomotic leaks and duration of surgery.
Methods: All patients surgically treated for colon cancer with a primary bowel anastomosis from 2004 through 2011 were included (n = 998). Duration of stay, surgery, and postoperative complication rates was compared between hand-sewn and stapled anastomosis.
Results: The number of stapled anastomoses grew significantly from 45.8% in 2004-2007 to 80.3% in 2008-2011 (p < 0.001), and an increasing portion of those is performed in laparoscopic procedures (29.8 to 43.3%; p = 0.01). Surgeries using stapled anastomosis initially took longer, but a decreasing trend (2004-2007: 147.5 min to 2007-2011: 124 min; p < 0.001) along with an increasing duration in hand-sewn surgeries (94-118.5 min; p < 0.01) meant stapled procedures became shorter than hand-sewn procedures by 2009. Complication rates did not differ significantly between groups, with stapled anastomoses having lower percentages of anastomotic leaks (1.6 vs. 2.4%; p = 0.38). By the second half of our research period, the median admission for patients with stapled anastomoses was two days shorter (4 vs. 6 days; p < 0.001), independently of the chosen approach.
Conclusion: Stapled anastomoses did not increase anastomotic leak rates. If anything, leak rates appeared slightly lower. In addition, stapled anastomoses significantly shortened operation duration. With the benefit of being a tool that facilitates minimally invasive surgery, it is a safe way to improve efficiency, reduce costs, and promote faster and better recovery.
