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Garoufalia Z, Emile SH, Zhou P, Gefen R, Horesh N, Strassmann V, Ray-Offor E, DaSilva G, Wexner SD. Stapler size independently predicts postoperative complications following stapled ileocolic anastomosis: A retrospective cohort study. Colorectal Dis 2024; 26:348-355. [PMID: 38158622 DOI: 10.1111/codi.16841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 11/13/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024]
Abstract
AIM Staplers used in ileocolic anastomosis construction differ in length and height. We assessed the impact of stapler type in creating ileocolic anastomoses on postoperative outcomes. METHODS This retrospective cohort study of an Institutional Review Board approved database included patients who underwent laparoscopic right colectomy for cancer between January 2011 and August 2021. All patients had construction of extracorporeal antiperistaltic stapled ileocolic anastomosis using a linear cutting stapler. Main outcome measures were short-term (<30 day) morbidity and mortality. RESULTS In all, 270 patients (136 men; median age 70.2 years) were included. A 75 mm stapler was used in 49 (18.1%) patients, 80 mm in 97 (35.9%) and 100 mm in 124 (45.9%). Blue cartridge (stapler height 3.5 mm) was used in 175 (64.5%) and green cartridge (4.8 mm) in 18 (7%) patients; this information was unavailable in 77 (28.5%) cases. Apical enterotomy closure was performed by linear stapler in 54% and linear cutting stapler in 46%. Apical staple line reinforcement or imbrication suturing was used in 26.3%. The overall postoperative complication rate was 28.9%. The anastomotic leak rate was 2.6%. Independent predictors of complications after laparoscopic right colectomy were older age (OR 1.03, 95%CI 1-1.06; P = 0.01), extended colectomy (OR 2.76, 95%CI 1.07-7.08; P = 0.035) and emergency surgery (OR 4.5, 95%CI 1.3-14.9; P = 0.014). A 100-mm linear cutting stapler was an independent protective factor against postoperative complications (OR 0.3, 95%CI 0.18-0.85; P = 0.019). Stapler height and closure technique of apical enterotomy did not affect postoperative complications. CONCLUSION Independent predictors of complications after laparoscopic right colectomy were older age, extended colectomy and emergency surgery. Using a 100 mm stapler was an independent protective factor against postoperative complications.
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Affiliation(s)
- Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
| | - Sameh Hany Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
- General Surgery Department, Colorectal Surgery Unit, Mansoura University Hospitals, Mansoura, Egypt
| | - Peige Zhou
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
- Georgia Colon and Rectal Surgical Associates, Northside Hospital, Atlanta, Georgia, USA
| | - Rachel Gefen
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
- Department of General Surgery, Faculty of Medicine, Hadassah Medical Organization, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nir Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
- Department of Surgery and Transplantations, Sheba Medical Center, Ramat Gan, Israel
| | - Victor Strassmann
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
| | - Emeka Ray-Offor
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
- Department of Surgery, University of Port Harcourt Choba, Choba, Nigeria
| | - Giovanna DaSilva
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
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Solís‐Peña A, Cirera A, Kraft Carré M, Pellino G, Espín‐Basany E. A standardized stepwise approach to minimally invasive ileocolic anastomosis: Tips and tricks for laparoscopic and robotic surgery. Colorectal Dis 2022; 24:1238-1242. [PMID: 35460173 PMCID: PMC9790292 DOI: 10.1111/codi.16159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/28/2022] [Accepted: 04/12/2022] [Indexed: 12/30/2022]
Abstract
AIM Intracorporeal anastomosis has been associated with earlier recovery of postoperative bowel function, shorter length of stay and lower surgical site infection rates. The aim of this work is to describe a step-by-step standardized technique for intracorporeal ileocolic and ileosigmoid anastomosis suitable for laparoscopic and robotic colectomy. METHOD Each step of the technique is illustrated using a composite collection of three operative patient videos. Two procedures were performed robotically and one was laparoscopic. Tips are provided to construct a two-layer anastomosis (both posteriorly and anteriorly). The procedures are presented in stepwise fashion, discussing the advantages and feasibility of the technique. RESULTS The standardized technique described herein was used in three patients for this report, of whom two underwent right colectomy and one subtotal colectomy for cancer. The median operating time was 255 (206-333) min. There were no intraoperative complications. No major postoperative complications or 30-day readmissions occurred. The median length of stay was 4 (3-5) days. CONCLUSION The described technique of a two-layer anastomosis can be used with any available minimally invasive approach. It is safe and feasible. Using a standardized approach, the technique can be easily taught and mastered, optimizing operating times and reducing adverse events.
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Affiliation(s)
- Alejandro Solís‐Peña
- Colorectal SurgeryVall d'Hebron University HospitalUniversitat Autònoma de Barcelona (UAB)BarcelonaSpain
| | - Arturo Cirera
- Colorectal SurgeryVall d'Hebron University HospitalUniversitat Autònoma de Barcelona (UAB)BarcelonaSpain
| | - Miquel Kraft Carré
- Colorectal SurgeryVall d'Hebron University HospitalUniversitat Autònoma de Barcelona (UAB)BarcelonaSpain
| | - Gianluca Pellino
- Colorectal SurgeryVall d'Hebron University HospitalUniversitat Autònoma de Barcelona (UAB)BarcelonaSpain,Department of Advanced Medical and Surgical SciencesUniversità degli Studi della Campania “Luigi Vanvitelli”NaplesItaly
| | - Eloy Espín‐Basany
- Colorectal SurgeryVall d'Hebron University HospitalUniversitat Autònoma de Barcelona (UAB)BarcelonaSpain
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Biondi A, Di Mauro G, Morici R, Sangiorgio G, Vacante M, Basile F. Intracorporeal versus Extracorporeal Anastomosis for Laparoscopic Right Hemicolectomy: Short-Term Outcomes. J Clin Med 2021; 10:jcm10245967. [PMID: 34945264 PMCID: PMC8705171 DOI: 10.3390/jcm10245967] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 11/16/2022] Open
Abstract
Laparoscopic right hemicolectomy represents an effective therapeutic approach for right colon cancer (RCC). The primary aim of this study was to evaluate bowel function recovery, length of hospital stay, operative time, and the number of general and anastomosis-related postoperative complications from intracorporeal anastomosis (ICA) vs. extracorporeal anastomosis (ECA); the secondary outcome was the number of lymph nodes retrieved. This observational study was conducted on 108 patients who underwent right hemicolectomy for RCC; after surgical resection, 64 patients underwent ICA and 44 underwent ECA. The operative time was slightly longer in the ICA group than in the ECA group, even though the difference was not significant (199.31 ± 48.90 min vs. 183.64 ± 35.80 min; p = 0.109). The length of hospital stay (7.53 ± 1.91 days vs. 8.77 ± 3.66 days; p = 0.036) and bowel function recovery (2.21 ± 1.01 days vs. 3.45 ± 1.82 days; p < 0.0001) were significantly lower in the ICA group. There were no significant differences in postoperative complications (12% in ICA group vs. 9% in ECA group), wound infection (6% in ICA group vs. 7% in ECA group), or anastomotic leakage (6% in ICA group vs. 9% in ECA group). We did not observe a significant difference between the two groups in the number of lymph nodes collected (19.46 ± 7.06 in ICA group vs. 22.68 ± 8.79 in ECA group; p = 0.086). ICA following laparoscopic right hemicolectomy, compared to ECA, could lead to a significant improvement in bowel function recovery and a reduction in the length of hospital stay in RCC patients.
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Affiliation(s)
- Antonio Biondi
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Via S. Sofia 78, 95123 Catania, Italy; (A.B.); (R.M.); (G.S.); (F.B.)
| | - Gianluca Di Mauro
- Unit of General Surgery, University Hospital Policlinico-San Marco, 95123 Catania, Italy;
| | - Riccardo Morici
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Via S. Sofia 78, 95123 Catania, Italy; (A.B.); (R.M.); (G.S.); (F.B.)
| | - Giuseppe Sangiorgio
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Via S. Sofia 78, 95123 Catania, Italy; (A.B.); (R.M.); (G.S.); (F.B.)
| | - Marco Vacante
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Via S. Sofia 78, 95123 Catania, Italy; (A.B.); (R.M.); (G.S.); (F.B.)
- Correspondence:
| | - Francesco Basile
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Via S. Sofia 78, 95123 Catania, Italy; (A.B.); (R.M.); (G.S.); (F.B.)
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Nasseri Y, Kasheri E, Oka K, Cox B, Cohen J, Ellenhorn J, Barnajian M. Minimally invasive right versus left colectomy for cancer: does robotic surgery mitigate differences in short-term outcomes? J Robot Surg 2021; 16:875-881. [PMID: 34581955 DOI: 10.1007/s11701-021-01310-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/19/2021] [Indexed: 01/11/2023]
Abstract
Studies comparing right (RC) and left colectomies (LC) show higher rates of ileus in RC and higher wound infection and anastomotic leak rates in LC. However, prior studies did not include robotic procedures. We compared short-term outcomes of laparoscopic and robotic RC and LC for cancer, with sub-analysis of robotic procedures. In a retrospective review of a prospective database, preoperative factors, intraoperative events, and 30-day postoperative outcomes were compared. Student's t tests and Chi-square tests were used for continuous and categorical variables, respectively. A logistic binomial regression was performed to assess whether type of surgery was associated with postoperative complications. Between January 2014 and August 2020, 115 patients underwent minimally invasive RC or LC for cancer. Sixty-eight RC [30 (44.1%) laparoscopic, 38 (55.9%) robotic] and 47 LC [13 (27.6%) laparoscopic, 34 (72.4%) robotic] cases were included. On univariate analysis, RC patients had significantly higher overall postoperative complications but no differences in rates of ileus/small bowel obstruction, wound infection, time to first flatus/bowel movement, length of hospital stay, and 30-day readmissions. On multivariate analysis, there was no significant difference in overall complications and laparoscopic surgery had a 2.5 times higher likelihood of complications than robotic surgery. In sub-analysis of robotic cases, there was no significant difference among all outcome variables. Previously reported outcome differences between laparoscopic RC and LC for cancer may be mitigated by robotic surgery.
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Affiliation(s)
- Yosef Nasseri
- Surgery Group of Los Angeles, 8635 West 3rd Street, Suite 880W, Los Angeles, CA, 90048, USA. .,Department of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Eli Kasheri
- Surgery Group of Los Angeles, 8635 West 3rd Street, Suite 880W, Los Angeles, CA, 90048, USA
| | - Kimberly Oka
- Surgery Group of Los Angeles, 8635 West 3rd Street, Suite 880W, Los Angeles, CA, 90048, USA
| | - Brian Cox
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jason Cohen
- Surgery Group of Los Angeles, 8635 West 3rd Street, Suite 880W, Los Angeles, CA, 90048, USA.,Department of General Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Joshua Ellenhorn
- Surgery Group of Los Angeles, 8635 West 3rd Street, Suite 880W, Los Angeles, CA, 90048, USA.,Department of Surgical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Moshe Barnajian
- Surgery Group of Los Angeles, 8635 West 3rd Street, Suite 880W, Los Angeles, CA, 90048, USA.,Department of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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