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Ileocolonic anastomosis after right hemicolectomy for carcinoma: stapled or hand-sewn?

A prospective, multicenter, randomized trial

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

440 patients were prospectively enrolled in a randomized, multicenter trial to compare 4 types of manual (84 interrupted end-to-end, 77 continuous end-to-side) 82 interrupted end-to-side, and 91 continuous end-to-side (polyglycolic derived suture) and 1 type of stapled (106 side-to-side with GIA + TA devices) ileocolonic anastomosis after right hemicolectomy for carcinoma. The trial was designed according to Schwartz' pragmatic formulation. All 5 groups were well-matched, except for a lower rate of intraoperative sepsis in the stapled group (P<0.02). The main end point was anastomotic leakage detected clinically or by routine sodium diatrizoate enema on the 8–10th postoperative day. Results showed that stapled ileocolonic anastomosis was associated with less anastomotic leakages (2.8%) than all the other techniques combined (8.3%). In spite of the fact that staples are approximately ten times more expensive, our results suggest performing side-to-side (GIA + TA) mechanical anastomosis after right resection for carcinoma.

Résumé

440 malades ont été inclus prospectivement dans un essai multi-centrique randomisé afin de comparer 4 types de sutures manuelles avec un fil lentement résorbable (84 sutures termino-terminales à points séparés, 77 termino-terminales par sujet, 82 latéro-terminales à points séparés et 91 termino-latérales par sujet) et une variété d'anastomoses mécaniques (106 sutures latéro-latérales aux pinces GIA + TA). Il s'agissait d'anastomoses iléo-coliques après hémicolectomie droite pour cancer. L'essai a été réalisé selon la formulation pragmatique de Schwartz. Tous les 5 groupes étaient bien appareillés à l'exception du plus petit taux de suppuration dans le groupe par anastomose mécanique (P<0.02). Le principal résultat était le lachâge d'anastomose détecté cliniquement ou par un lavement de routine aux produits hydrosolubles au 8–10ème jour post-opératoire. Les résultats montraient que les anastomoses mécaniques étaient associées avec moins de lachage d'anastomose (2,8%) que toutes les autres techniques (8,3%). En dépit du fait que les anastomoses mécaniques sont approximativement 10 fois plus chères, nos résultats suggèrent qu'il faut réaliser des anastomoses latéro-larérales (GIA + TA) mécaniques après hémi-colectomie droite pour cancer.

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References

  1. Chassin JL, Rifkind KM, Sussmann B (1978) The stapled gastrointestinal tract anastomosis; incidence of postoperative complications compared with the sutured anastomosis. Ann Surg 188:689–696

    Google Scholar 

  2. Editorial (1980) Sepsis after bowel surgery. Br J Med 28:882–883

  3. Steichen FM (1968) The use of staplers in anatomical side-to-side and functional end-to-end anastomoses. Surgery 64:948–953

    Google Scholar 

  4. Steichen FM, Ravitch MM. Mechanical sutures in surgery (1973) Br J Surg 70:191–197

    Google Scholar 

  5. Adloff M, Turbelin JM (1982) Hémicolectomie droite avec anastomose colo-iléale “première”. Modifications apportées par les procédés de suture mécanique. Nouv Press Med 1:1075–1077

    Google Scholar 

  6. Brodman RF, Brodman HR (1981) Staple suturing of the colon above the peritoneal reflection. Arch Surg 11:191–192

    Google Scholar 

  7. Brennan SS, Pickford IR, Evans M, Pollock AV (1982) Staples or sutures for colonic anastomoses—A controlled clinical trial. Br J Surg 69:722–724

    Google Scholar 

  8. Everett WG, Friend PJ, Forty J (1986) Comparison of stapling and hand-suture for left-sided large bowel anastomosis. Br J Surg 73:345–348

    Google Scholar 

  9. Rodary M, Hay JM, Fingerhut A, Oberlin P (1987) Conventional mechanical preparation versus whole-gut irrigation for elective colonic resection: a multicentric prospective controlled trial. Colo proctology 9:87–93

    Google Scholar 

  10. French Association for surgical Research, Rodary M, Fingerhut A, Hay JM (1988) Mechanical and antibiotic preparation of the bowel for elective colorectal surgery. Three-day versus oneday preparation. Colo proctology 5:271–276

    Google Scholar 

  11. French Association for Surgical Research, Rodary M, Fingerhut A, Hay JM (1991) Povidone-iodine enemas and one-day antibiotic prophylaxis: A continuous search for the ideal bowel preparation for elective colonic surgery. A multicenter controlled trial. Colo proctology 13:5–12

    Google Scholar 

  12. Cancer Research Campaign Working Party (1980) Trials and tribulations: Thoughts on the organization of multicentre clinical studies. Br Med J 281:918–920

    Google Scholar 

  13. Evans M, Pollack AV (1984) Trials on trial. A review of trials on antibiotic prophylaxis. Arch Surg 119:109–113

    Google Scholar 

  14. Schwartz D, Flamant R, Lellouch J (1980) Clinical trials. Academic Press Inc, London

    Google Scholar 

  15. Murray GD (1991) Statistical aspects of research methology. Br J Surg 78:777–781

    Google Scholar 

  16. Lorentz FH (1929) Ein neuer Konstitutionsindex. Klin Wochenschr 16:348–351

    Google Scholar 

  17. Goligher J, Graham NG, De Dombal FT (1979) Anastomotic dehiscence after anterior resection of rectum and sigmoid. Br J Surg 57:109–118

    Google Scholar 

  18. Scher KS, Scott-Connor C, Jones CW, Leach M (1982) A comparison of stapled and sutured anastomoses in colonic operations. Surg Gynecol Obstet 155:489–493

    Google Scholar 

  19. West of Scotland and Highland Anastomosis Study Group (1991) Suturing or stapling in gastrointestinal surgery: a prospective randomized study. Br J Surg 78:337–341

    Google Scholar 

  20. Solomkin JS, Dellinger EP, Christou NV, Mason AD (1987) Design and conduct of antibiotic trials. A report of the Scientific Studies Committee of the Surgical Infection Society. Arch Surg 122:158–164

    Google Scholar 

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Authors and Affiliations

  1. French Association for Surgical Research, Bois-Colombes, France

    M. Kracht, J. -M. Hay, P. -L. Fagniez & A. Fingerhut

Authors
  1. M. Kracht
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  2. J. -M. Hay
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  3. P. -L. Fagniez
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  4. A. Fingerhut
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Additional information

The following surgeons participated in this study: F. Benhamida (Sens), J.-L. Bernard (Orléans), P. Breil (Clichy), J. Chipponi (Clermont-Ferrand), J.-C. Cour (Tours), F. Dazza (Paris), J.-P. Delalande (Pithiviers), B. Descottes (Limoges), G. Desvignes (Montargis), C. Devien (Saint-Cloud), E. Dewulf (Brussels), A. El Hadad, D. Brassier (Aulnay-sous-Bois), P.-L. Fagniez, M. Kracht, N. Rotman, C. Thomsen (Créteil), A. Fingerhut, P. Oberlin, J. Pourcher (Poissy), J. Francin (Quimperlé), J.-M. Hay, Y. Flamant, F. Lacaine, G. Zeitoun (Colombes), H. Hennet (Romorantin), G. Kohlmann (Corbeil), R. Kaswin (Le Mans), A. Konrat (Compiègne), B. Lagadec (Paris), P. Laigneau (Meaux), X. Pouliquen, B. Vacher (Argenteuil), F. Poulton (St-Brieuc), J. Renaud (Longjumeau), M. Rodary (Orsay), F. Rouffet (Juvisy), M. Sage (Auxerre), J.-L. Sicard (Nice), M. Timmermans (Ottignies)

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Kracht, M., Hay, J.M., Fagniez, P.L. et al. Ileocolonic anastomosis after right hemicolectomy for carcinoma: stapled or hand-sewn?. Int J Colorect Dis 8, 29–33 (1993). https://doi.org/10.1007/BF00341273

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  • DOI: https://doi.org/10.1007/BF00341273

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