Ileocolonic anastomosis: preferred techniques in 999 patients. A multicentric study
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ORIGINAL ARTICLE
Ileocolonic anastomosis: preferred techniques in 999 patients. A multicentric study Stefano Puleo • Maria Sofia • Maria A. Trovato • Antonio Pesce • Teresa R. Portale • Domenico Russello Gaetano La Greca
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Received: 30 November 2011 / Accepted: 30 July 2012 Ó Springer Japan 2012
Abstract Purpose There is no standard anastomosis technique for performing reconstruction after right hemicolectomy, and, in the literature, studies on ileocolonic anastomosis are rare. The aim of this retrospective work was to analyze the type of anastomosis techniques used and the related results in a multicentric enquiry. Methods A questionnaire was sent to the departments of surgery covering a 1.8 million inhabitant area to collect data concerning the anastomosis techniques used and the results related to complications. Results Data for 999 patients from 14 departments of surgery were collected. 95.8 % of the patients were affected by cancer and 4.2 % were affected by inflammatory bowel disease (IBD). The positioning of the anastomosing bowel was side-to-side in 60.5 % of the patients, end-to-side (E–S) in 38.1 % of the patients and end-to-end in 1.3 % of the patients. 46.4 % of the anastomoses were handsewn and 53.6 % were stapled. The complication rate in the cancer group was 5.1 % for handsewn techniques and 4.7 % for stapled techniques. The rate of anastomotic leakage was higher in the handsewn group than that in the stapled group (P \ 0.05). The data for the IBD group were not statistically relevant. Conclusions This wide multicentric retrospective analysis showed that there remains variability in ileocolonic anastomosis techniques. Stapled anastomoses are associated with a lower incidence of leakage. In stapled anastomoses,
S. Puleo M. Sofia (&) M. A. Trovato A. Pesce T. R. Portale D. Russello G. La Greca Department of Surgical Science Organ Transplantations and Advanced Technologies, University of Catania, Via del Bosco, 324, 95125 Catania, Italy e-mail: [email protected]
the E–S configuration is also related to a lower incidence of leakage. Keywords Right hemicolectomy Ileocolonic anastomosis Anastomotic leakage
Introduction Performing ileocolic anastomosis after right hemicolectomy is one of the basic skills of a general surgeon and it is usually used in the management of right colonic neoplasms and inflammatory bowel disease (IBD) involving the ileum or right colon. Unlike left hemicolectomy, ileocolonic anastomosis includes several technical options for configuration and suture type, such as handsewn or stapled techniques. For a long time, the handsewn technique was employed; however, today, mechanical stapling devices are widely used in gastrointestinal surgery. The stapler has many advantages: a better blood supply, less tissue manipulation, minimal edema, uniformity of sutures, easy lumen calibration and short operative times [1]. Stapled or handsewn anastomoses are primarily classified into two types: side-to-side (S–S) anastomosis (or functional end-to-end) using a linear st
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