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Doğru V, Ashburn JH, Akova U, Sutter AG, Esen E, Gardner EM, da Luz Moreira A, Erkan A, Kirat J, Grieco MJ, Remzi FH. Stapled End-To-Side Ileocolic Anastomosis in Crohn's Disease: Old Dog, Reliable Tricks? A Retrospective Two-Center Cohort Study. ANNALS OF SURGERY OPEN 2024; 5:e374. [PMID: 38883936 PMCID: PMC11175959 DOI: 10.1097/as9.0000000000000374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 12/08/2023] [Indexed: 06/18/2024] Open
Abstract
Objective Analyze our long-term experience with a less-popularized but stalwart approach, the stapled end-to-side ileocolic anastomosis. Background The choice of technical approach to ileocolic anastomosis after ileocecal resection for Crohn's disease affects surgical outcomes and recurrence. Yet, despite heterogeneous data from different anastomotic configurations, there remains no clear guidance as to the optimal technique. Methods In a retrospective cohort design, patients undergoing ileocolic anastomosis in the setting of Crohn's disease between 2016 and 2021 at two institutions were identified. Patient characteristics and surgical outcomes in terms of recurrence (surgical, clinical, and endoscopic) were studied. Results In total, 211 patients were included. Before surgery, 80% were exposed to at least 1 cycle of systemic steroids and 71% had at least 1 biologic agent; 60% exhibited penetrating disease and 38% developed an intra-abdominal abscess. After surgery, one anastomosis leaked (0.5%). Over 2.4 years of follow-up (IQR = 1.3-3.9), surgical recurrence was 0.9%. Two-year overall recurrence-free and endoscopic recurrence-free survivals were 74% and 85% (95% CI = 68-81 and 80-91), respectively. The adjusted hazard ratio of endoscopic recurrence was 3.0 (95% CI = 1.4-6.2) for males and 5.2 (1.2-22) for patients who received systemic steroids before the surgery. Conclusion The stapled end-to-side anastomosis is an efficient, reliable, and reproducible approach to maintain bowel continuity after ileocecal resection with durable outcomes. Our outcomes demonstrate low rates of disease recurrence and stand favorably in comparison to other more technically complex or protracted anastomotic approaches. This anastomosis is an ideal reconstructive approach after ileocecal resection for Crohn's disease.
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Affiliation(s)
- Volkan Doğru
- From the Inflammatory Bowel Disease Center, NYU Langone Health, New York, NY
| | - Jean H Ashburn
- Department of Surgery, Wake Forest University Baptist Health, Winston-Salem, NC
| | - Umut Akova
- From the Inflammatory Bowel Disease Center, NYU Langone Health, New York, NY
| | - Alton G Sutter
- Department of Surgery, Wake Forest University Baptist Health, Winston-Salem, NC
| | - Eren Esen
- From the Inflammatory Bowel Disease Center, NYU Langone Health, New York, NY
| | - Emily M Gardner
- Department of Surgery, Wake Forest University Baptist Health, Winston-Salem, NC
| | | | - Arman Erkan
- From the Inflammatory Bowel Disease Center, NYU Langone Health, New York, NY
| | - John Kirat
- From the Inflammatory Bowel Disease Center, NYU Langone Health, New York, NY
| | - Michael J Grieco
- From the Inflammatory Bowel Disease Center, NYU Langone Health, New York, NY
| | - Feza H Remzi
- From the Inflammatory Bowel Disease Center, NYU Langone Health, New York, NY
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2
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Zhou Y, Zhou Y, Wang C, Ye R, Lin X, Tan S, Chen W, Mi Y, Yang C, Lin S, Li W. Intraoperative and postoperative short-term outcomes of intracorporeal anastomosis versus extracorporeal anastomosis in laparoscopic right hemicolectomy. Front Oncol 2023; 13:1145579. [PMID: 37124506 PMCID: PMC10130395 DOI: 10.3389/fonc.2023.1145579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/27/2023] [Indexed: 05/02/2023] Open
Abstract
Background Intracorporeal anastomosis (IA) is a difficult but popular anastomotic approach for reconstruction of digestive tract after laparoscopic right hemicolectomy, which may reduce some limitations faced during extracorporeal anastomosis (EA). Methods A retrospective review of 78 patients who underwent laparoscopic right hemicolectomy by a veteran surgeon in a high-volume public tertiary hospital, including 50 patients with IA and 28 patients with EA. The intraoperative-related factors and short-term results of the two anastomotic approaches were compared. Results There was no significant difference in demographics and clinical characteristics between the two groups (P>0.05). The intraoperative blood loss was less (P=0.010) and the incision length was shorter (P<0.001) in the intracorporeal group. Postoperative farting time was faster (P=0.005) and postoperative pain score (VAS) was lower (P<0.001) in IA group. Although the anastomotic time of IA was shorter (P<0.001), the operative time of the two groups were similar. And number of lymph nodes harvested, NLR from POD1 to POD3, postoperative hospital stay and overall hospital stay between the two groups were comparable. Except for significant difference in abdominal infection rate, the Clavien-Dindo classification and the incidence of other postoperative complications were not statistically different. Moreover, the morbidity of abdominal infection decreased with time in the IA group (P=0.040). Conclusion IA is a reliable and feasible procedure, which has faster anastomotic time, earlier return of bowel function and superior postoperative comfort of patient, compared to EA. The postoperative complication rate of IA is similar to that of EA, and may be improved with the IA technical maturity of surgeons, which potentially contributes to the development of ERAS.
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Affiliation(s)
- Yuhang Zhou
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Yuchen Zhou
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Chuandong Wang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Rong Ye
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xiaojun Lin
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Song Tan
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Weijie Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Yulong Mi
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Changshun Yang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Shengtao Lin
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
- *Correspondence: Shengtao Lin, ; Weihua Li,
| | - Weihua Li
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
- *Correspondence: Shengtao Lin, ; Weihua Li,
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Hu Y, Duan J, Yang X, Zhang C, Fu W. Wettability and biological responses of titanium surface's biomimetic hexagonal microstructure. J Biomater Appl 2023; 37:1112-1123. [PMID: 36154504 DOI: 10.1177/08853282221121883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this research, an experiment was conducted on how the surface wettability and biocompatibility of staplers' titanium nails impact the healing of gastrointestinal tissue. Firstly, the bionic hexagonal structure was prepared on the surface of Ti metal by laser processing technology, and the laser textured titanium samples were observed by scanning electron microscope. Then, the liquid-solid contact angle-measuring instrument was used to characterize the wettability of titanium samples. Finally, cells were cultured on the surface of different titanium samples, CCK8 assay and qRT-PCR were carried out to investigate cell adhesion and collagen secretion on the surface of different samples. The results showed that the bionic hexagonal surface increased the surface roughness, reduced the liquid-solid contact angle, and promoted the adhesion and collagen secretion of fibroblasts. The increased wettability provided a better growth environment for cell growth. Microtexture is an important factor affecting the behavior of cells and its size parameters regulate cell gene expression, which is worthy of further study.
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Affiliation(s)
- Yahui Hu
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, National Demonstration Center for Experimental Mechanical and Electrical Engineering Education,66346Tianjin University of Technology, Tianjin, China
| | - Junyu Duan
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, National Demonstration Center for Experimental Mechanical and Electrical Engineering Education,66346Tianjin University of Technology, Tianjin, China
| | - Xiaoyang Yang
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, National Demonstration Center for Experimental Mechanical and Electrical Engineering Education,66346Tianjin University of Technology, Tianjin, China
| | - Chunqiu Zhang
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, National Demonstration Center for Experimental Mechanical and Electrical Engineering Education,66346Tianjin University of Technology, Tianjin, China
| | - Weihua Fu
- Department of General Surgery, 12610Tianjin Medical University General Hospital, Tianjin, China
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4
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Würtz HJ, Bundgaard L, Rahr HB, Frostberg E. Anastomosis technique and leakage rates in minimally invasive surgery for right-sided colon cancer. A retrospective national cohort study. Int J Colorectal Dis 2022; 37:701-708. [PMID: 35150297 DOI: 10.1007/s00384-022-04107-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study was to describe the different techniques currently used in Denmark to construct right-sided ileocolic anastomoses in minimally invasive surgery, and investigate, compare and analyse the anastomotic configurations and their anastomotic leakage (AL) rates. METHODS This was a retrospective register-based, study design using prospectively collected data from the Danish Colorectal Cancer Group (DCCG) database. All patients aged 18 years or older with a malignant colorectal tumour in Denmark in the period of 1 February 2015 until 31 December 2019, and who had an elective, curative, minimally invasive right hemicolectomy (MIRH) with ileocolic anastomosis, were included. RESULTS Three thousand three hundred ninety-eight patients were included. The most commonly used anastomotic approach was the extracorporeal (EC) hand-sewn anastomosis (HA) with end-to-end configuration (59%) and the second most used was the EC stapled anastomosis (SA) side-to-side configuration (20%). The latter had a higher AL rate compared with the hand-sewn technique (3.8% vs. 1.3%), and had significantly higher odds ratio (OR) (OR: 2.85, 95% CI: 1.56-4.92, p < 0.0001) for AL in the adjusted regression model. The least used technique was the end-to-side HA which also had a significantly higher OR (OR: 3.05, 95% CI: 1.30-7.15, p = 0.010) compared with the end-to-end HA. Smoking was an independent factor associated with higher OR for AL. CONCLUSION The ileocolic end-to-end HA was the most commonly used technique and had the lowest AL rate in MIRH for colon cancer. The EC SA technique and tobacco smoking were independent risk factors for leakage of the ileocolic anastomosis.
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Affiliation(s)
- Helene Juul Würtz
- Department of Surgery, Danish Colorectal Cancer Center South, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark.
| | - Lars Bundgaard
- Department of Surgery, Danish Colorectal Cancer Center South, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Hans B Rahr
- Department of Surgery, Danish Colorectal Cancer Center South, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark.,The Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Erik Frostberg
- Department of Surgery, Danish Colorectal Cancer Center South, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
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5
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Development of a polymeric biomedical device platform with controlled disassembly and in vivo testing in a swine intestinal model. Sci Rep 2022; 12:3208. [PMID: 35217701 PMCID: PMC8881572 DOI: 10.1038/s41598-022-06339-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 12/10/2021] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to create a surgical guide platform that maintains its integrity while the surgeon performs an intestinal anastomosis or another similar procedure, which then breaks apart and is eliminated from the body in a controlled manner. The device contains mixed polymeric structures that give it a controlled rate of disassembly that could meet the requirements of a specific surgical purpose. The intraluminal anastomotic guide was manufactured as a hollow cylinder composed of layers of porous polyurethane/PCL with polyvinylpyrrolidone as the binding agent similar to a "brick-mortar" architecture. This combination of polymeric structures is a promising manufacturing method from which a variety of tunable devices can be fabricated for specific medical procedures and site-specific indications. The guide was designed to rapidly disassemble within the intestinal lumen after use, reliably degrading while maintaining sufficient mechanical rigidity and stability to support manipulation during complex surgical procedures. The nature of the device's disassembly makes it suitable for use in hollow structures that discharge their contents, resulting in their elimination from the body. A swine model of intestinal anastomosis was utilized to validate the use and function of the device.
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Chen W, Zhou J, Chen M, Jiang C, Qian Q, Ding Z. Isoperistaltic side-to-side anastomosis for the surgical treatment of Crohn disease. Ann Surg Treat Res 2022; 103:53-61. [PMID: 35919111 PMCID: PMC9300438 DOI: 10.4174/astr.2022.103.1.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/19/2022] [Accepted: 06/20/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Wenhao Chen
- Department of Colorectal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Inflammatory Bowel Diseases Center, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Intestinal & Colorectal Diseases, Quality Control Center of Colorectal Surgery, Health Commission of Hubei Province, Wuhan, China
| | - Junjie Zhou
- Department of Colorectal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Inflammatory Bowel Diseases Center, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Intestinal & Colorectal Diseases, Quality Control Center of Colorectal Surgery, Health Commission of Hubei Province, Wuhan, China
| | - Min Chen
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Congqing Jiang
- Department of Colorectal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Intestinal & Colorectal Diseases, Quality Control Center of Colorectal Surgery, Health Commission of Hubei Province, Wuhan, China
| | - Qun Qian
- Department of Colorectal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Inflammatory Bowel Diseases Center, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Intestinal & Colorectal Diseases, Quality Control Center of Colorectal Surgery, Health Commission of Hubei Province, Wuhan, China
| | - Zhao Ding
- Department of Colorectal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Inflammatory Bowel Diseases Center, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Intestinal & Colorectal Diseases, Quality Control Center of Colorectal Surgery, Health Commission of Hubei Province, Wuhan, China
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7
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Watanabe K, Sasaki I, Kohyama A, Suzuki H, Kobayashi M, Kajiwara T, Karasawa H, Ohnuma S, Kamei T, Unno M. Antimesenteric cutback end-to-end isoperistaltic anastomosis (Sasaki-Watanabe anastomosis) for Crohn's disease: Novel surgical technique and early results of surgical anastomotic recurrence. Ann Gastroenterol Surg 2021; 5:528-537. [PMID: 34337302 PMCID: PMC8316746 DOI: 10.1002/ags3.12445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/21/2020] [Accepted: 01/27/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Antimesenteric cutback end-to-end isoperistaltic anastomosis (Sasaki-Watanabe anastomosis; Sasaki-W anastomosis), which was developed in our department, is a novel hand-sewn anastomotic technique for Crohn's disease intended to prevent anastomotic stenosis and preserve the peripheral circulation. AIM The aim of the present study is to present the surgical technique of Sasaki-W anastomosis and to assess the safety and the early results of the surgical anastomotic recurrence of Sasaki-W anastomosis. PATIENTS AND METHODS The present study was a single-center retrospective cohort study. As an early-period group, 13 patients with Crohn's disease, who were mainly selected from cases considered to be at high risk of recurrence, underwent 15 Sasaki-W anastomoses from August 2009 to January 2012. As a late-period group, 36 patients with Crohn's disease, who were selected regardless of risk factors, underwent 37 Sasaki-W anastomoses from September 2016 to March 2020. The medical data including patient characteristics, surgical records, postoperative details, and surgical recurrences were assessed. RESULTS There were no intraoperative complications. With a median follow-up of 107 mo, surgical recurrence occurred in one patient at 106 mo after surgery in the early-period group. The cumulative surgical recurrence-free rate in the early-period group was 100% at 5 y and 86% at 10 y after surgery. No patients required reoperation in the late-period group. CONCLUSION Sasaki-W anastomosis is safe and feasible. Although long-term study is needed, this anastomotic technique can be a reasonable operative option for Crohn's disease.
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Affiliation(s)
- Kazuhiro Watanabe
- Department of SurgeryTohoku University Graduate School of MedicineSendaiJapan
| | | | - Atsushi Kohyama
- Department of SurgeryTohoku University Graduate School of MedicineSendaiJapan
| | - Hideyuki Suzuki
- Department of SurgeryTohoku University Graduate School of MedicineSendaiJapan
| | - Minoru Kobayashi
- Department of SurgeryTohoku University Graduate School of MedicineSendaiJapan
| | - Taiki Kajiwara
- Department of SurgeryTohoku University Graduate School of MedicineSendaiJapan
| | - Hideaki Karasawa
- Department of SurgeryTohoku University Graduate School of MedicineSendaiJapan
| | - Shinobu Ohnuma
- Department of SurgeryTohoku University Graduate School of MedicineSendaiJapan
| | - Takashi Kamei
- Department of SurgeryTohoku University Graduate School of MedicineSendaiJapan
| | - Michiaki Unno
- Department of SurgeryTohoku University Graduate School of MedicineSendaiJapan
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8
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Objective recovery time with end-to-side versus side-to-side anastomosis after laparoscopic right hemicolectomy for colon cancer: a randomized controlled trial. Surg Endosc 2021; 36:2499-2506. [PMID: 34008107 DOI: 10.1007/s00464-021-08536-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Despite reports of the short-term benefits of end-to-side versus side-to-side anastomosis, we are aware of no prospective studies in which these methods were compared. We hypothesized the superiority of end-to-side over side-to-side anastomosis in terms of recovery after laparoscopic right hemicolectomy for colon cancer under an enhanced recovery program. METHODS From September 2016 to August 2019, 130 patients were randomly allocated to receive end-to-side or side-to-side anastomosis at a single tertiary hospital in Korea. The primary outcome was the cumulative recovery rate seven days after surgery, defined as the percentage of patients who met all four recovery criteria: diet tolerance, no analgesia, safe ambulation, and an afebrile status. Student's t test, the Mann-Whitney U test, the χ2 test, and Fisher's exact test were used to compare variables, as applicable. RESULTS The cumulative recovery rate at seven days did not differ between patients receiving end-to-side (92.3%, 60/65) or side-to-side anastomosis (92.3%, 60/65; P ≥ 0.999). The end-to-side and side-to-side groups had similar cumulative recovery rates at postoperative days 4, 5, and 6 (end-to-side vs. side-to-side: 41.5% vs 35.4%, P = 0.589; 73.8% vs 63.1%, P = 0.257; and 86.2% vs 81.5%, P = 0.634, respectively). None of the secondary endpoints differed for end-to-side vs. side-to-side anastomosis: the median length of postoperative hospitalization (5 [IQR 5-7] vs. 6 [IQR 5-7] days, respectively, P = 0.376), the 30-day complication rate (16.9% vs. 12.3%, respectively, P = 0.620), the enhanced recovery protocol failure rate (10.8% vs. 7.7%, respectively, P = 0.763), and the 30-day readmission rate (4.6% vs. 3.1%, respectively, P ≥ 0.999). CONCLUSIONS End-to-side anastomosis was not superior to side-to-side anastomosis in terms of recovery criteria after laparoscopic right hemicolectomy. These findings do not provide evidence for a functional advantage of end-to-side compared to side-to-side anastomosis.
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Celentano V, Pellino G, Spinelli A, Selvaggi F, Celentano V, Pellino G, Rottoli M, Poggioli G, Sica G, Giglio MC, Campanelli M, Coco C, Rizzo G, Sionne F, Colombo F, Sampietro G, Lamperti G, Foschi D, Ficari F, Vacca L, Cricchio M, Giudici F, Selvaggi L, Sciaudone G, Peltrini R, Manfreda A, Bucci L, Galleano R, Ghazouani O, Zorcolo L, Deidda S, Restivo A, Braini A, Di Candido F, Sacchi M, Carvello M, Martorana S, Bordignon G, Angriman I, Variola A, Di Ruscio M, Barugola G, Geccherle A, Tropeano FP, Luglio G, Tanzanu M, Sasia D, Migliore M, Giuffrida MC, Marrano E, Moretto G, Impellizzeri H, Gallo G, Vescio G, Sammarco G, Terrosu G, Calini G, Bondurri A, Maffioli A, Zaffaroni G, Resegotti A, Mistrangelo M, Allaix ME, Botti F, Prati M, Boni L, Perotti S, Mineccia M, Giuliani A, Romano L, Graziano GMP, Pugliese L, Pietrabissa A, Delaini G, Spinelli A, Selvaggi F. Anastomosis configuration and technique following ileocaecal resection for Crohn's disease: a multicentre study. Updates Surg 2021; 73:149-156. [PMID: 33409848 DOI: 10.1007/s13304-020-00918-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/26/2020] [Indexed: 12/15/2022]
Abstract
A limited ileocaecal resection is the most frequently performed procedure for ileocaecal CD and different anastomotic configurations and techniques have been described. This manuscript audited the different anastomotic techniques used in a national study and evaluated their influence on postoperative outcomes following ileocaecal resection for primary CD. This is a retrospective, multicentre, observational study promoted by the Italian Society of Colorectal Surgery (SICCR), including all adults undergoing elective ileocaecal resection for primary CD from June 2018 May 2019. Postoperative morbidity within 30 days of surgery was the primary endpoint. Postoperative length of hospital stay (LOS) and anastomotic leak rate were the secondary outcomes. 427 patients were included. The side to side anastomosis was the chosen configuration in 380 patients (89%). The stapled anastomotic (n = 286; 67%), techniques were preferred to hand-sewn (n = 141; 33%). Postoperative morbidity was 20.3% and anastomotic leak 3.7%. Anastomotic leak was independent of the type of anastomosis performed, while was associated with an ASA grade ≥ 3, presence of perianal disease and ileocolonic localization of disease. Four predictors of LOS were identified after multivariate analysis. The laparoscopic approach was the only associated with a reduced LOS (p = 0.017), while age, ASA grade ≥ 3 or administration of preoperative TPN were associated with increased LOS. The side to side was the most commonly used anastomotic configuration for ileocolic reconstruction following primary CD resection. There was no difference in postoperative morbidity according to anastomotic technique and configuration. Anastomotic leak was associated with ASA grade ≥ 3, a penetrating phenotype of disease and ileo-colonic distribution of CD.
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Affiliation(s)
- Valerio Celentano
- Portsmouth Hospitals NHS Trust, Portsmouth, UK. .,University of Portsmouth, Portsmouth, UK. .,Department of Surgery and Cancer, Imperial College, London, UK.
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Science, Universita' degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Antonino Spinelli
- Colon and Rectal Surgery Unit, Humanitas Clinical and Research Center, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Francesco Selvaggi
- Department of Advanced Medical and Surgical Science, Universita' degli Studi della Campania Luigi Vanvitelli, Naples, Italy
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Ng CH, Chin YH, Lin SY, Koh JWH, Lieske B, Koh FHX, Chong CS, Foo FJ. Kono-S anastomosis for Crohn's disease: a systemic review, meta-analysis, and meta-regression. Surg Today 2020; 51:493-501. [PMID: 32894346 DOI: 10.1007/s00595-020-02130-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/25/2020] [Indexed: 12/13/2022]
Abstract
The Kono-S anastomosis was introduced in 2011 as an alternative anastomosis in Crohn's disease (CD) surgery. Since then, prevailing evidence of the favorable results of the Kono-S anastomosis has been published from around the world. We conducted this study to analyze the effectiveness of the Kono-S anastomosis, by searching Medline, Embase, CNKI, and google scholar. Binominal data were analyzed after Freeman-Tukey double-arcsine transformation. Comparative data were analyzed using the Mantel-Haenszel model for dichotomous outcomes and the mean difference for continuous outcomes. We identified 676 patients who underwent surgery with a Kono-S anastomosis. Surgical recurrence was pooled at an average of 0% (CI: 0.00-0.01) and a reduced mean Rutgeerts score of 1.375 (CI: 0.727-2.023) after Kono-S anastomosis. Endoscopic recurrence after sensitivity analysis was 5% (CI: 0.00-0.15). Complications were rare, with a 3% incidence of ileus (CI: 0.01-0.05), a 4% incidence of small bowel obstruction (CI: 0.01-0.10), a 1% incidence of an anastomotic leak incidence (CI: 0.00-0.03), and a 10% incidence of postoperative infection (CI: 0.03-0.20). Evidence from this meta-analysis favors the Kono-S anastomosis for CD patients, especially for ileocolic anastomosis. Thus, clinicians should consider the applicability of Kono-S anastomosis in respective institutions.
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Affiliation(s)
- Cheng Han Ng
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Snow Yunni Lin
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | | | - Bettina Lieske
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore.,Division of Colorectal Surgery, Department of Surgery, National University Hospital, Singapore, Singapore
| | | | - Choon Seng Chong
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore. .,Division of Colorectal Surgery, Department of Surgery, National University Hospital, Singapore, Singapore.
| | - Fung Joon Foo
- Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
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Jurowich C, Lichthardt S, Matthes N, Kastner C, Haubitz I, Prock A, Filser J, Germer CT, Wiegering A. Effects of anastomotic technique on early postoperative outcome in open right-sided hemicolectomy. BJS Open 2018; 3:203-209. [PMID: 30957068 PMCID: PMC6433329 DOI: 10.1002/bjs5.101] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/01/2018] [Indexed: 12/14/2022] Open
Abstract
Background Despite recent improvements in colonic cancer surgery, the rate of anastomotic leakage after right hemicolectomy is still around 6–7 per cent. This study examined whether anastomotic technique (handsewn or stapled) after open right hemicolectomy for right‐sided colonic cancer influences postoperative complications. Methods Patient data from the German Society for General and Visceral Surgery (StuDoQ) registry from 2010 to 2017 were analysed. Univariable and multivariable analyses were performed. The primary endpoint was anastomotic leakage; secondary endpoints were postoperative ileus, complications and length of postoperative hospital stay (LOS). Results A total of 4062 patients who had undergone open right hemicolectomy for colonic cancer were analysed. All patients had an ileocolic anastomosis, 2742 handsewn and 1320 stapled. Baseline characteristics were similar. No significant differences were identified in anastomotic leakage, postoperative ileus, reoperation rate, surgical‐site infection, LOS or death. The stapled group had a significantly shorter duration of surgery and fewer Clavien–Dindo grade I–II complications. In multivariable logistic regression analysis, ASA grade and BMI were found to be significantly associated with postoperative complications such as anastomotic leakage, postoperative ileus and reoperation rate. Conclusion Handsewn and stapled ileocolic anastomoses for open right‐sided colonic cancer resections are equally safe. Stapler use was associated with reduced duration of surgery and significantly fewer minor complications.
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Affiliation(s)
- C Jurowich
- Department of General, Visceral and Thoracic Surgery Kreiskliniken Altötting/Burghausen Altötting Germany.,Department of General, Visceral, Vascular and Paediatric Surgery, University Hospital University of Würzburg Würzburg Germany
| | - S Lichthardt
- Department of General, Visceral, Vascular and Paediatric Surgery, University Hospital University of Würzburg Würzburg Germany
| | - N Matthes
- Department of General, Visceral, Vascular and Paediatric Surgery, University Hospital University of Würzburg Würzburg Germany
| | - C Kastner
- Department of General, Visceral, Vascular and Paediatric Surgery, University Hospital University of Würzburg Würzburg Germany
| | - I Haubitz
- Department of General, Visceral, Vascular and Paediatric Surgery, University Hospital University of Würzburg Würzburg Germany
| | - A Prock
- Department of General, Visceral and Thoracic Surgery Kreiskliniken Altötting/Burghausen Altötting Germany
| | - J Filser
- Department of General, Visceral and Thoracic Surgery Kreiskliniken Altötting/Burghausen Altötting Germany
| | - C-T Germer
- Department of General, Visceral, Vascular and Paediatric Surgery, University Hospital University of Würzburg Würzburg Germany.,Comprehensive Cancer Centre Mainfranken University of Würzburg Medical Centre Würzburg Germany
| | - A Wiegering
- Department of General, Visceral, Vascular and Paediatric Surgery, University Hospital University of Würzburg Würzburg Germany.,Comprehensive Cancer Centre Mainfranken University of Würzburg Medical Centre Würzburg Germany.,Department of Biochemistry and Molecular Biology University of Würzburg Würzburg Germany
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