Anastomotic bleeding following ileocolic end-to-side anastomosis using a circular stapler: incidence and risk factors
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ORIGINAL ARTICLE
Anastomotic bleeding following ileocolic end‑to‑side anastomosis using a circular stapler: incidence and risk factors Tatsuki Noguchi1 · Shigenobu Emoto1 · Kazushige Kawai1 · Takeshi Nishikawa1 · Yasutaka Shuno1 · Kazuhito Sasaki1 · Manabu Kaneko1 · Koji Murono1 · Hiroaki Ishii1 · Hirofumi Sonoda1 · Toshiaki Tanaka1 · Keisuke Hata1 · Hiroaki Nozawa1 · Soichiro Ishihara1 Received: 6 March 2020 / Accepted: 16 April 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Purpose To identify the incidence of and risk factors for postoperative bleeding after ileocolic end-to-side anastomosis using a circular stapler. Methods We analyzed, retrospectively, the risk factors for postoperative anastomotic bleeding in patients who underwent right-sided colectomy with end-to-side anastomosis done using a circular stapler during colon tumor surgery at our institute between January 2015 and March 2019. Results Anastomotic bleeding developed in 10 (3.6%) of the total 279 patients. Univariate analysis revealed that age ≥ 80 years (8.8% vs. 1.9%; P = 0.008) and Eastern Cooperative Oncology Group performance status (ECOG PS) ≥ 1 (12.5% vs. 2.8%; P = 0.014) were significant risk factors for anastomotic bleeding. Postoperative anticoagulation therapy was not a risk factor for anastomotic bleeding. Multivariate analysis revealed that only age ≥ 80 years was an independent risk factor (odds ratio 4.12, 95% confidence interval 1.02–16.68, P = 0.047). Six of the ten patients with anastomotic bleeding were treated conservatively, three were treated by colonoscopic clipping, and one required surgery. Conclusion End-to-side anastomosis is safe and feasible, but must be performed carefully in the elderly, who are at higher risk of anastomotic bleeding. Keywords Anastomotic bleeding · Ileocolic end-to-side anastomosis · Right colectomy
Introduction Stapled ileocolic anastomosis is widely accepted as an alternative to conventional hand-sewn anastomosis in colon cancer surgery. However, complications from stapled anastomoses, such as leakage and hemorrhage, are not uncommon, despite the more efficient stapling devices now available [1]. The incidence of postoperative hemorrhage from colonic anastomosis has been reported to range 0.5–5.4% [2–4]. Although the risk factors for anastomotic leakage are reported widely, the risk factors for anastomotic bleeding, especially after right colectomy, are mentioned in only a few studies [1, 3, 5-12]. Furthermore, perioperative venous thromboembolism (VTE) prophylaxis, which can trigger * Tatsuki Noguchi [email protected] 1
Department of Surgical Oncology, The University of Tokyo, 7‑3‑1, Hongo, Bunkyo‑ku, Tokyo 113‑8655, Japan
hemorrhagic events, is now used commonly in colorectal surgery [13]. End-to-side anastomosis using a circular stapler has been reported to have a higher incidence of anastomotic bleeding than linear-stapled side-to-side or functional end-toend anastomosis and hand-sewn side-to-side anastomosis. Although linear-stapled side-to-side anastomosis is used
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