Relationship between method of anastomosis and anastomotic failure after right hemicolectomy and ileo-caecal resection: an international snapshot audit

T. Pinkney; N. Battersby; A. Bhangu; S. Chaudhri; A. El-Hussuna; M. Frasson; D. Nepogodiev; B. Singh; S. Vennix; O. Zmora; D. Altomare; W. Bemelman; P. Christensen; A. D'Hoore; S. Laurberg; D. Morton; T. Pinkney; M. Rubbini; C. Vaizey; L. Magill; R. Perry; N. Sheward; N. Ives; S. Mehta; M. Cillo; D. Estefania; J. Patron Uriburu; H. Ruiz; M. Salomon; A. Makhmudov; L. Selnyahina; A. Varabei; Y. Vizhynis; D. Claeys; B. Defoort; F. Muysoms; P. Pletinckx; V. Vergucht; I. Debergh; T. Feryn; H. Reusens; M. Nachtergaele; D. Francart; C. Jehaes; S. Markiewicz; B. Monami; J. Weerts; J. Melenhorst; C. van Rossem; V. Klemann; European Soc Coloproctology Collab; Writing Grp ESCP Cohort Studies; Audits Sub-Comm; ESCP Res Comm; Logistical Support Data Collation; Local Investigators

doi:10.1111/codi.13646

Relationship between method of anastomosis and anastomotic failure after right hemicolectomy and ileo-caecal resection: an international snapshot audit

T. Pinkney^*, N. Battersby, A. Bhangu, S. Chaudhri, A. El-Hussuna, M. Frasson, D. Nepogodiev, B. Singh, S. Vennix, O. Zmora, D. Altomare, W. Bemelman, P. Christensen, A. D'Hoore, S. Laurberg, D. Morton, T. Pinkney, M. Rubbini, C. Vaizey, L. MagillR. Perry, N. Sheward, N. Ives, S. Mehta, M. Cillo, D. Estefania, J. Patron Uriburu, H. Ruiz, M. Salomon, A. Makhmudov, L. Selnyahina, A. Varabei, Y. Vizhynis, D. Claeys, B. Defoort, F. Muysoms, P. Pletinckx, V. Vergucht, I. Debergh, T. Feryn, H. Reusens, M. Nachtergaele, D. Francart, C. Jehaes, S. Markiewicz, B. Monami, J. Weerts, J. Melenhorst, C. van Rossem, V. Klemann, European Soc Coloproctology Collab, Writing Grp ESCP Cohort Studies, Audits Sub-Comm, ESCP Res Comm, Logistical Support Data Collation, Local Investigators

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Aim The anastomosis technique used following right-sided colonic resection is widely variable and may affect patient outcome. This study aimed to assess the association between leak and anastomosis technique (stapled vs handsewn).

Method This was a prospective, multicentre, international audit including patients undergoing elective or emergency right hemicolectomy or ileo-caecal resection operations over a 2-month period in early 2015. The primary outcome measure was the presence of anastomotic leak within 30 days of surgery, determined using a prespecified definition. Mixed effects logistic regression models were used to assess the association between leak and anastomosis method, adjusting for patient, disease and operative cofactors, with centre included as a random-effect variable.

Results This study included 3208 patients, of whom 78.4% (n = 2515) underwent surgery for malignancy and 11.7% (n = 375) underwent surgery for Crohn's disease. An anastomosis was performed in 94.8% (n = 3041) of patients, which was handsewn in 38.9% (n = 1183) and stapled in 61.1% (n = 1858). Patients undergoing hand-sewn anastomosis were more likely to be emergency admissions (20.5% handsewn vs 12.9% stapled) and to undergo open surgery (54.7% handsewn vs 36.6% stapled). The overall anastomotic leak rate was 8.1% (245/3041), which was similar following handsewn (7.4%) and stapled (8.5%) techniques (P = 0.3). After adjustment for cofactors, the odds of a leak were higher for stapled anastomosis (adjusted OR = 1.43; 95% CI: 1.04-1.95; P = 0.03).

Conclusion Despite being used in lower-risk patients, stapled anastomosis was associated with an increased anastomotic leak rate in this observational study. Further research is needed to define patient groups in whom a stapled anastomosis is safe.

Original language	English
Pages (from-to)	e296-e311
Number of pages	16
Journal	Colorectal Disease
Volume	19
Issue number	8
DOIs	https://doi.org/10.1111/codi.13646
Publication status	Published - Aug 2017

Keywords

Anastomotic leak
colorectal cancer
Crohn's disease
epidemiology
international
RISK-FACTORS
LEAK
SURGERY
COMPLICATIONS
DEFINITION
MORTALITY

Access to Document

10.1111/codi.13646

Cite this

Pinkney, T., Battersby, N., Bhangu, A., Chaudhri, S., El-Hussuna, A., Frasson, M., Nepogodiev, D., Singh, B., Vennix, S., Zmora, O., Altomare, D., Bemelman, W., Christensen, P., D'Hoore, A., Laurberg, S., Morton, D., Pinkney, T., Rubbini, M., Vaizey, C., ... Local Investigators (2017). Relationship between method of anastomosis and anastomotic failure after right hemicolectomy and ileo-caecal resection: an international snapshot audit. Colorectal Disease, 19(8), e296-e311. https://doi.org/10.1111/codi.13646

@article{a9fc485d1a6048808c9a48211a41fd67,

title = "Relationship between method of anastomosis and anastomotic failure after right hemicolectomy and ileo-caecal resection: an international snapshot audit",

abstract = "Aim The anastomosis technique used following right-sided colonic resection is widely variable and may affect patient outcome. This study aimed to assess the association between leak and anastomosis technique (stapled vs handsewn).Method This was a prospective, multicentre, international audit including patients undergoing elective or emergency right hemicolectomy or ileo-caecal resection operations over a 2-month period in early 2015. The primary outcome measure was the presence of anastomotic leak within 30 days of surgery, determined using a prespecified definition. Mixed effects logistic regression models were used to assess the association between leak and anastomosis method, adjusting for patient, disease and operative cofactors, with centre included as a random-effect variable.Results This study included 3208 patients, of whom 78.4% (n = 2515) underwent surgery for malignancy and 11.7% (n = 375) underwent surgery for Crohn's disease. An anastomosis was performed in 94.8% (n = 3041) of patients, which was handsewn in 38.9% (n = 1183) and stapled in 61.1% (n = 1858). Patients undergoing hand-sewn anastomosis were more likely to be emergency admissions (20.5% handsewn vs 12.9% stapled) and to undergo open surgery (54.7% handsewn vs 36.6% stapled). The overall anastomotic leak rate was 8.1% (245/3041), which was similar following handsewn (7.4%) and stapled (8.5%) techniques (P = 0.3). After adjustment for cofactors, the odds of a leak were higher for stapled anastomosis (adjusted OR = 1.43; 95% CI: 1.04-1.95; P = 0.03).Conclusion Despite being used in lower-risk patients, stapled anastomosis was associated with an increased anastomotic leak rate in this observational study. Further research is needed to define patient groups in whom a stapled anastomosis is safe.",

keywords = "Anastomotic leak, colorectal cancer, Crohn's disease, epidemiology, international, RISK-FACTORS, LEAK, SURGERY, COMPLICATIONS, DEFINITION, MORTALITY",

author = "T. Pinkney and N. Battersby and A. Bhangu and S. Chaudhri and A. El-Hussuna and M. Frasson and D. Nepogodiev and B. Singh and S. Vennix and O. Zmora and D. Altomare and W. Bemelman and P. Christensen and A. D'Hoore and S. Laurberg and D. Morton and T. Pinkney and M. Rubbini and C. Vaizey and L. Magill and R. Perry and N. Sheward and N. Ives and S. Mehta and M. Cillo and D. Estefania and {Patron Uriburu}, J. and H. Ruiz and M. Salomon and A. Makhmudov and L. Selnyahina and A. Varabei and Y. Vizhynis and D. Claeys and B. Defoort and F. Muysoms and P. Pletinckx and V. Vergucht and I. Debergh and T. Feryn and H. Reusens and M. Nachtergaele and D. Francart and C. Jehaes and S. Markiewicz and B. Monami and J. Weerts and J. Melenhorst and {van Rossem}, C. and V. Klemann and {European Soc Coloproctology Collab} and {Writing Grp ESCP Cohort Studies} and {Audits Sub-Comm} and {ESCP Res Comm} and {Logistical Support Data Collation} and {Local Investigators}",

year = "2017",

month = aug,

doi = "10.1111/codi.13646",

language = "English",

volume = "19",

pages = "e296--e311",

journal = "Colorectal Disease",

issn = "1462-8910",

publisher = "Wiley",

number = "8",

}

Pinkney, T, Battersby, N, Bhangu, A, Chaudhri, S, El-Hussuna, A, Frasson, M, Nepogodiev, D, Singh, B, Vennix, S, Zmora, O, Altomare, D, Bemelman, W, Christensen, P, D'Hoore, A, Laurberg, S, Morton, D, Pinkney, T, Rubbini, M, Vaizey, C, Magill, L, Perry, R, Sheward, N, Ives, N, Mehta, S, 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, Melenhorst, J , van Rossem, C, Klemann, V, European Soc Coloproctology Collab, Writing Grp ESCP Cohort Studies, Audits Sub-Comm, ESCP Res Comm, Logistical Support Data Collation & Local Investigators 2017, 'Relationship between method of anastomosis and anastomotic failure after right hemicolectomy and ileo-caecal resection: an international snapshot audit', Colorectal Disease, vol. 19, no. 8, pp. e296-e311. https://doi.org/10.1111/codi.13646

TY - JOUR

T1 - Relationship between method of anastomosis and anastomotic failure after right hemicolectomy and ileo-caecal resection

T2 - an international snapshot audit

AU - Pinkney, T.

AU - Battersby, N.

AU - Bhangu, A.

AU - Chaudhri, S.

AU - El-Hussuna, A.

AU - Frasson, M.

AU - Nepogodiev, D.

AU - Singh, B.

AU - Vennix, S.

AU - Zmora, O.

AU - Altomare, D.

AU - Bemelman, W.

AU - Christensen, P.

AU - D'Hoore, A.

AU - Laurberg, S.

AU - Morton, D.

AU - Pinkney, T.

AU - Rubbini, M.

AU - Vaizey, C.

AU - Magill, L.

AU - Perry, R.

AU - Sheward, N.

AU - Ives, N.

AU - Mehta, S.

AU - Cillo, M.

AU - Estefania, D.

AU - Patron Uriburu, J.

AU - Ruiz, H.

AU - Salomon, M.

AU - Makhmudov, A.

AU - Selnyahina, L.

AU - Varabei, A.

AU - Vizhynis, Y.

AU - Claeys, D.

AU - Defoort, B.

AU - Muysoms, F.

AU - Pletinckx, P.

AU - Vergucht, V.

AU - Debergh, I.

AU - Feryn, T.

AU - Reusens, H.

AU - Nachtergaele, M.

AU - Francart, D.

AU - Jehaes, C.

AU - Markiewicz, S.

AU - Monami, B.

AU - Weerts, J.

AU - Melenhorst, J.

AU - van Rossem, C.

AU - Klemann, V.

AU - European Soc Coloproctology Collab

AU - Writing Grp ESCP Cohort Studies

AU - Audits Sub-Comm

AU - ESCP Res Comm

AU - Logistical Support Data Collation

AU - Local Investigators

PY - 2017/8

Y1 - 2017/8

N2 - Aim The anastomosis technique used following right-sided colonic resection is widely variable and may affect patient outcome. This study aimed to assess the association between leak and anastomosis technique (stapled vs handsewn).Method This was a prospective, multicentre, international audit including patients undergoing elective or emergency right hemicolectomy or ileo-caecal resection operations over a 2-month period in early 2015. The primary outcome measure was the presence of anastomotic leak within 30 days of surgery, determined using a prespecified definition. Mixed effects logistic regression models were used to assess the association between leak and anastomosis method, adjusting for patient, disease and operative cofactors, with centre included as a random-effect variable.Results This study included 3208 patients, of whom 78.4% (n = 2515) underwent surgery for malignancy and 11.7% (n = 375) underwent surgery for Crohn's disease. An anastomosis was performed in 94.8% (n = 3041) of patients, which was handsewn in 38.9% (n = 1183) and stapled in 61.1% (n = 1858). Patients undergoing hand-sewn anastomosis were more likely to be emergency admissions (20.5% handsewn vs 12.9% stapled) and to undergo open surgery (54.7% handsewn vs 36.6% stapled). The overall anastomotic leak rate was 8.1% (245/3041), which was similar following handsewn (7.4%) and stapled (8.5%) techniques (P = 0.3). After adjustment for cofactors, the odds of a leak were higher for stapled anastomosis (adjusted OR = 1.43; 95% CI: 1.04-1.95; P = 0.03).Conclusion Despite being used in lower-risk patients, stapled anastomosis was associated with an increased anastomotic leak rate in this observational study. Further research is needed to define patient groups in whom a stapled anastomosis is safe.

AB - Aim The anastomosis technique used following right-sided colonic resection is widely variable and may affect patient outcome. This study aimed to assess the association between leak and anastomosis technique (stapled vs handsewn).Method This was a prospective, multicentre, international audit including patients undergoing elective or emergency right hemicolectomy or ileo-caecal resection operations over a 2-month period in early 2015. The primary outcome measure was the presence of anastomotic leak within 30 days of surgery, determined using a prespecified definition. Mixed effects logistic regression models were used to assess the association between leak and anastomosis method, adjusting for patient, disease and operative cofactors, with centre included as a random-effect variable.Results This study included 3208 patients, of whom 78.4% (n = 2515) underwent surgery for malignancy and 11.7% (n = 375) underwent surgery for Crohn's disease. An anastomosis was performed in 94.8% (n = 3041) of patients, which was handsewn in 38.9% (n = 1183) and stapled in 61.1% (n = 1858). Patients undergoing hand-sewn anastomosis were more likely to be emergency admissions (20.5% handsewn vs 12.9% stapled) and to undergo open surgery (54.7% handsewn vs 36.6% stapled). The overall anastomotic leak rate was 8.1% (245/3041), which was similar following handsewn (7.4%) and stapled (8.5%) techniques (P = 0.3). After adjustment for cofactors, the odds of a leak were higher for stapled anastomosis (adjusted OR = 1.43; 95% CI: 1.04-1.95; P = 0.03).Conclusion Despite being used in lower-risk patients, stapled anastomosis was associated with an increased anastomotic leak rate in this observational study. Further research is needed to define patient groups in whom a stapled anastomosis is safe.

KW - Anastomotic leak

KW - colorectal cancer

KW - Crohn's disease

KW - epidemiology

KW - international

KW - RISK-FACTORS

KW - LEAK

KW - SURGERY

KW - COMPLICATIONS

KW - DEFINITION

KW - MORTALITY

U2 - 10.1111/codi.13646

DO - 10.1111/codi.13646

M3 - Article

C2 - 28263043

SN - 1462-8910

VL - 19

SP - e296-e311

JO - Colorectal Disease

JF - Colorectal Disease

IS - 8

ER -