Influence of suture technique on anastomotic leakage rate—a retrospective analyses comparing interrupted—versus continuous—sutures

2018 ◽  
Vol 34 (1) ◽  
pp. 55-61 ◽  
Author(s):  
Roman Eickhoff ◽  
Simon B. Eickhoff ◽  
Serdar Katurman ◽  
Christian D. Klink ◽  
Daniel Heise ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Suture Technique ◽  
Leakage Rate ◽  
Anastomotic Leakage Rate

P103 A HAND-SEWN INTRATHORACIC ANASTOMOSIS IN ROBOT-ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY (RAMIE): A DETAILED DESCRIPTION OF TECHNIQUE AND OUTCOMES

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
E M de Groot ◽  
B F Kingma ◽  
R van Hillegersberg ◽  
J P Ruurda
Keyword(s):  
Anastomotic Leakage ◽  
Moving Average ◽  
Minimally Invasive Esophagectomy ◽  
Leakage Rate ◽  
Gastric Conduit ◽  
Robot Assisted ◽  
Intrathoracic Anastomosis ◽  
Invasive Esophagectomy ◽  
Anastomotic Leakage Rate ◽  
Technical Details

Abstract Aim The aim of this study was to describe a technique that was developed and refined to construct a hand-sewn intrathoracic anastomosis during robot-assisted minimally invasive esophagectomy (RAMIE). Background & Methods Whilst some case series have reported promising results of a hand-sewn intrathoracic anastomosis during RAMIE, the exact techniques were often not described in detail. Therefore, the current single-center retrospective study was designed to provide a detailed and reproducible technical description of a hand-sewn, intrathoracic anastomosis that was developed and refined for patients who underwent RAMIE in a high volume center for esophageal cancer surgery (2016-2018). Video recordings were reviewed to evaluate technical details regarding the anastomosis, including number of sutures and distances between the anastomosis and the longitudinal staple line or gastric conduit tip. Technical details and distances were extracted and measured by using video analysis software. Moving average analyses were performed to evaluate whether the anastomotic leakage rate changed over the consecutive cases. Results A total of 68 patients were included in the study. For creation of the anastomosis, the gastric conduit was opened on a median distance of 19 millimeters (range 0-66) from the gastric conduit tip. After initially performing end-to-end anastomoses, a switch was made to an end-to-side anastomosis for the majority of 55 patients (81%). A median total of 27 sews (range 20-38) were required to close the anastomosis. In the last 22 patients of the cohort (32%), 4 tension release stitches were placed after circular suturing of the anastomosis. A re-inforcing omental wrap was positioned around the anastomosis in 64 patients (94%). The moving average curve for anastomotic leakage started at a rate of 40% (cases 1-10) and ended at 10% (cases 59-68). Conclusion This is the first study to report technical features and outcomes of a hand-sewn intrathoracic anastomosis during RAMIE in detail. Although an acceptable anastomotic leakage rate was observed in the final inclusion phase, a hand-sewn intrathoracic anastomosis during RAMIE may carry a substantial learning curve.

scholarly journals Systematic Review of Anastomotic Leakage Rate According to an International Grading System Following Anterior Resection for Rectal Cancer

PLoS ONE ◽  
2013 ◽  
Vol 8 (9) ◽  
pp. e75519 ◽  
Author(s):  
Zhi-Jie Cong ◽  
Liang-Hao Hu ◽  
Zheng-Qian Bian ◽  
Guang-Yao Ye ◽  
Min-Hao Yu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rectal Cancer ◽  
Anastomotic Leakage ◽  
Anterior Resection ◽  
Leakage Rate ◽  
Grading System ◽  
Anastomotic Leakage Rate

scholarly journals REINFORCEMENT OF STAPLE LINE OF COLORECTAL ANASTOMOSIS AS A METHOD OF LEAKEAGE PREVENTION

2018 ◽  
pp. 16-24 ◽  
Author(s):  
A. A. Balkarov ◽  
E. G. Rybakov ◽  
A. A. Ponomarenko ◽  
M. V. Alekseev ◽  
V. N. Kashnikov
Keyword(s):  
Anastomotic Leakage ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Staple Line ◽  
Colorectal Anastomosis ◽  
Main Group ◽  
Leakage Rate ◽  
Control Group ◽  
Colorectal Anastomoses ◽  
Anastomotic Leakage Rate

AIM: to decrease anastomotic leakage rate using transanal and transabdominal reinforcing sutures of staple line of colorectal anastomosis. PATIENTS AND METHODS: a prospective randomized trial is started. The main group included patients which underwent anterior or low anterior resection of the rectum with reinforcing of the staple line of colorectal anastomosis using reinforcing sutures on 2, 4, 6, 8, 10 and 12 by conventional dial. The control group consisted of patients without reinforcing of the anastomosis line. RESULTS: from November 2017 to October 2018, 127 patients underwent anterior or low anterior resection of the rectum, 80 of them were included in the study,six were excluded from the study after surgery. Among these 74 patients 40 (54.0 %) were females, mean age was 63.0± 11.0 years. Forty patients consisted the main group, 34 - control. The anastomotic leakage rate in the main group was 7% (3/40), in the control - was 26 % (9/34) (p=0.06). The clinical anastomotic leakage rate in the main group was 3 % (1/40), in the control group - 21 % (7/34) (p=0.03). The anastomotic leakage rate in the main group, after anterior resection of the rectum was 13 % (2/15), in the control - 0 % (0/8) (p=0.8). After low anterior resection the anastomotic leakage rate in the main group was 4 % (1/25), in the control - 35 % (9/26) (p=0.016). Multivariate analysis of risk factors of anastomotic leakage significance associated with male gender (OR 6.88, CI 1,32-of 35.9, p=0,022), positive bubble test (OR 6.26, CI of 1.22-32,2, p=0.028), absence of reinforcing of the anastomosis (OR 4.39, CI 0,96-20,12, p=0,056). CONCLUSION: the reinforcing of colorectal anastomoses decreases anastomotic leakage rate after low anterior resection.

scholarly journals Subtotal stomach in esophageal reconstruction surgery achieves an anastomotic leakage rate of less than 1%

2020 ◽  
Vol 4 (4) ◽  
pp. 422-432
Author(s):  
Kazuhiro Yoshida ◽  
Yoshihiro Tanaka ◽  
Takeharu Imai ◽  
Yuta Sato ◽  
Yuji Hatanaka ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Leakage Rate ◽  
Esophageal Reconstruction ◽  
Reconstruction Surgery ◽  
Anastomotic Leakage Rate

scholarly journals Microscopic inflammation in ileocecal specimen does not correspond to a higher anastomotic leakage rate after ileocecal resection in Crohn’s disease

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247796
Author(s):  
Christian Schineis ◽  
Andrea Ullrich ◽  
Kai S. Lehmann ◽  
Christoph Holmer ◽  
Johannes C. Lauscher ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Anastomotic Leakage ◽  
Resection Margin ◽  
Frozen Section ◽  
Leakage Rate ◽  
Ileocecal Resection ◽  
Resection Margins ◽  
Anastomotic Leakage Rate ◽  
Microscopic Inflammation

Background Patients with Crohn’s disease suffer from a higher rate of anastomotic leakages after ileocecal resection than patients without Crohn’s disease. Our hypothesis was that microscopic inflammation at the resection margins of ileocecal resections in Crohn’s disease increases the rate of anastomotic leakages. Patients and methods In a retrospective cohort study, 130 patients with Crohn’s disease that underwent ileocecal resection between 2015 and 2019, were analyzed. Anastomotic leakage was the primary outcome parameter. Inflammation at the resection margin was characterized as “inflammation at proximal resection margin”, “inflammation at distal resection margin” or “inflammation at both ends”. Results 46 patients (35.4%) showed microscopic inflammation at the resection margins. 17 patients (13.1%) developed anastomotic leakage. No difference in the rate of anastomotic leakages was found for proximally affected resection margins (no anastomotic leakage vs. anastomotic leakage: 20.3 vs. 35.3%, p = 0.17), distally affected resection margins (2.7 vs. 5.9%, p = 0.47) or inflammation at both ends (9.7 vs. 11.8%, p = 0.80). No effect on the anastomotic leakage rate was found for preoperative hemoglobin concentration (no anastomotic leakage vs. anastomotic leakage: 12.3 vs. 13.5 g/dl, p = 0.26), perioperative immunosuppressive medication (62.8 vs. 52.9%, p = 0.30), BMI (21.8 vs. 22.4 m2/kg, p = 0.82), emergency operation (21.2 vs. 11.8%, p = 0.29), laparoscopic vs. open procedure (p = 0.58), diverting ileostomy (31.9 vs. 57.1%, p = 0.35) or the level of surgical training (staff surgeon: 80.5 vs. 76.5%, p = 0.45). Conclusion Microscopic inflammation at the resection margins after ileocecal resection in Crohn’s disease is common. Histologically inflamed resection margins do not appear to affect the rate of anastomotic leakages. Our data suggest that there is no need for extensive resections or frozen section to achieve microscopically inflammation-free resection margins.

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