Abstract
Background
Anastomotic leakage is a major complication in colorectal surgery. This study investigates a new method for reducing anastomotic failure using antitraction sutures.
Methods
In 2007, the authors began routine placement of three sutures at every one-third of the circular end-to-end anastomosis to reduce traction. Before the start of the new protocol, 76 patients received laparoscopic colorectal left sided surgery, 21 (28%) of whom received a defunctioning stoma. After the start of the new protocol, 77 patients received laparoscopic colorectal surgery, 6 (8%) of whom received a defunctioning stoma.
Results
Placement of a defunctioning stoma was significantly reduced (n = 21 vs. 6; P = 0.01). Only one patient (1%) in the sutured group experienced anastomotic leakage compared with six patients in the control group (P = 0.025). Other anastomosis-related complications during the follow-up period, including anastomotic stenosis and intraabdominal abscess, occurred more frequently in the control group, although the difference did not reach significance.
Conclusion
The use of antitraction sutures to support the anastomosis seems to reduce the occurrence of anastomotic leakage in laparoscopic left colorectal surgery. A prospective randomized trial is necessary to prove the decreasing effect of antitraction sutures on anastomotic leakage as well as the major decreasing effect on the necessity of placement of defunctioning stomas.
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References
Schlachta CM, Mamazza J, Gregoire R, Burpee SE, Poulin EC (2003) Could laparoscopic colon and rectal surgery become standard of care? A review and experience with 750 procedures. Can J Surg 46:432–440
Vignali A, Fazio VW, Lavery IC, Milsom JW, Church JM, Hull TL, Strong SA, Oakley JR (1997) Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1,014 patients. J Am Col Surg 185:105–113
Rose J, Schneider C, Yildirim C, Geers P, Scheidbach H, Köckerling F (2004) Complications in laparoscopic colorectal surgery: results of a multicentre trial. Tech Coloproctol 8:S25–S28
Matthiessen P, Hallböök O, Andersson M, Rutegård J, Sjödahl R (2004) Risk factors for anastomotic leakage after anterior resection of the rectum. Colorect Dis 6:462–469
Goriainov V, Miles AJ (2008) Anastomotic leak rate and outcome for laparoscopic intracorporeal stapled anastomosis. J Minim Access Surg 4:39–43
McArdle CS, McMillan DC, Hole DJ (2005) Impact of anastomotic leakage on long-term survival of patients undergoing curative resection for colorectal cancer. Br J Surg 92:1150–1154
Colon Cancer Laparoscopic or Open Resection Study Group, Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomized clinical trial. Lancet Oncol 10:44–52
Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM, MRC CLASICC trial group (2005) Short-term end points of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomized controlled trial. Lancet 365:1718–1726
Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059
Buunen M, Lange MM, Ditzel M, Kleinrensink GJ, van de Velde CJ, Lange JF (2009) Level of arterial ligation in total mesorectal excision (TME): an anatomical study. Int J Colorectal Dis 24:1317–1320
Van Deurzen DF, Mannaerts GH, Lange JF (2006) Technique for instant stapling of the sigmoid mesentery and mesorectum in laparoscopic colorectal surgery. Surg Endosc 20:1778–1779
Aalbers AG, Mannaerts GH (2006) Introduction of laparoscopic colorectal surgery in the Sint Franciscus Gasthuis, Rotterdam, 2002/2005. Neth J Med 150:1455–1461
Korolija D (2008) The current evidence on stapled versus hand-sewn anastomoses in the digestive tract. Minim Invasive Ther Allied Technol 17:151–154
Disclosures
Ralph P. M. Gadiot, Michalda S. Dunker, Amir Mearadji, and Guido H. H. Mannaerts have no conflicts of interest or financial ties to disclose.
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Gadiot, R.P.M., Dunker, M.S., Mearadji, A. et al. Reduction of anastomotic failure in laparoscopic colorectal surgery using antitraction sutures. Surg Endosc 25, 68–71 (2011). https://doi.org/10.1007/s00464-010-1131-x
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DOI: https://doi.org/10.1007/s00464-010-1131-x