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01-11-2020 | Colectomy | Original Article

Anastomotic bleeding following ileocolic end-to-side anastomosis using a circular stapler: incidence and risk factors

Authors: Tatsuki Noguchi, Shigenobu Emoto, Kazushige Kawai, Takeshi Nishikawa, Yasutaka Shuno, Kazuhito Sasaki, Manabu Kaneko, Koji Murono, Hiroaki Ishii, Hirofumi Sonoda, Toshiaki Tanaka, Keisuke Hata, Hiroaki Nozawa, Soichiro Ishihara

Published in: Surgery Today | Issue 11/2020

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.

Ishihara S, Watanabe T, Nagawa H. Intraoperative colonoscopy for stapled anastomosis in colorectal surgery. Surg Today. 2008;38(11):1063–5. https://doi.org/10.1007/s00595-007-3740-0.CrossRefPubMed

Neutzling CB, Lustosa SA, Proenca IM, da Silva EM, Matos D. Stapled versus handsewn methods for colorectal anastomosis surgery. Cochrane Database Syst Rev. 2012. https://doi.org/10.1002/14651858.CD003144.pub2.CrossRefPubMed

Martinez-Serrano MA, Pares D, Pera M, Pascual M, Courtier R, Egea MJ, et al. Management of lower gastrointestinal bleeding after colorectal resection and stapled anastomosis. Tech Coloproctol. 2009;13(1):49–53. https://doi.org/10.1007/s10151-009-0458-6.CrossRefPubMed

de Sevilla F, Gómez E, Vallribera Valls F, Espin Basany E, Valverde Lahuerta S, Pérez Lafuente M, Segarra Medrano A, et al. Postoperative small bowel and colonic anastomotic bleeding. Therapeutic management and complications. Cirugía Española (English Edition). 2014;92(7):463–7. https://doi.org/10.1016/j.cireng.2014.03.002.CrossRef

Hebert J, Eltonsy S, Gaudet J, Jose C. Incidence and risk factors for anastomotic bleeding in lower gastrointestinal surgery. BMC Res Notes. 2019;12(1):378. https://doi.org/10.1186/s13104-019-4403-0.CrossRefPubMedPubMedCentral

Golda T, Zerpa C, Kreisler E, Trenti L, Biondo S. Incidence and management of anastomotic bleeding after ileocolic anastomosis. Colorectal Dis. 2013;15(10):1301–8. https://doi.org/10.1111/codi.12309.CrossRefPubMed

Linn TY, Moran BJ, Cecil TD. Staple line haemorrhage following laparoscopic left-sided colorectal resections may be more common when the inferior mesenteric artery is preserved. Tech Coloproctol. 2008;12(4):289–93. https://doi.org/10.1007/s10151-008-0437-3.CrossRefPubMed

Besson R, Christidis C, Denet C, Bruyns L, Levard H, Gayet B, et al. Management of postoperative bleeding after laparoscopic left colectomy. Int J Colorectal Dis. 2016;31(8):1431–6. https://doi.org/10.1007/s00384-016-2612-8.CrossRefPubMed

Kosuge M, Eto K, Hashizume R, Takeda M, Tomori K, Neki K, et al. Which Is the safer anastomotic method for colon surgery?—Ten-year results. In Vivo. 2017;31(4):683–7. https://doi.org/10.21873/invivo.11113.CrossRefPubMedPubMedCentral

10.

Sciuto A, Merola G, De Palma GD, Sodo M, Pirozzi F, Bracale UM, et al. Predictive factors for anastomotic leakage after laparoscopic colorectal surgery. World J Gastroenterol. 2018;24(21):2247–60. https://doi.org/10.3748/wjg.v24.i21.2247.CrossRefPubMedPubMedCentral

11.

Elod EE, Cozlea A, Neagoe RM, Sala D, Darie R, Sardi K, et al. Safety of anastomoses in right hemicolectomy for colon cancer. Chirurgia (Bucur). 2019;114(2):191–9. https://doi.org/10.21614/chirurgia.114.2.191.CrossRef

12.

Rojas-Machado SA, Romero-Simo M, Arroyo A, Rojas-Machado A, Lopez J, Calpena R. Prediction of anastomotic leak in colorectal cancer surgery based on a new prognostic index PROCOLE (prognostic colorectal leakage) developed from the meta-analysis of observational studies of risk factors. Int J Colorectal Dis. 2016;31(2):197–21010. https://doi.org/10.1007/s00384-015-2422-4.CrossRefPubMed

13.

Emoto S, Nozawa H, Kawai K, Hata K, Tanaka T, Shuno Y, et al. Venous thromboembolism in colorectal surgery: Incidence, risk factors, and prophylaxis. Asian J Surg. 2019;42(9):863–73. https://doi.org/10.1016/j.asjsur.2018.12.013.CrossRefPubMed

14.

Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, et al. Prevention of VTE in nonorthopedic surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Suppl):e227S–e277S. https://doi.org/10.1378/chest.11-2297.CrossRefPubMedPubMedCentral

15.

Perez RO, Sousa A Jr, Bresciani C, Proscurshim I, Coser R, Kiss D, et al. Endoscopic management of postoperative stapled colorectal anastomosis hemorrhage. Tech Coloproctol. 2007;11(1):64–6. https://doi.org/10.1007/s10151-007-0330-5.CrossRefPubMed

16.

Kawai K, Iida Y, Ishihara S, Yamaguchi H, Nozawa H, Hata K, et al. Intraoperative colonoscopy in patients with colorectal cancer: Review of recent developments. Dig Endosc. 2016;28(6):633–40. https://doi.org/10.1111/den.12663.CrossRefPubMed

17.

Nozawa H, Shinagawa T, Kawai K, Hata K, Tanaka T, Nishikawa T, et al. Laparoscopic surgery in colon cancer patients treated with chronic anti-thrombotic therapy. Surg Endosc. 2018;32(8):3509–16. https://doi.org/10.1007/s00464-018-6071-x.CrossRefPubMed

18.

Hoedema RE, Luchtefeld MA. The management of lower gastrointestinal hemorrhage. Dis Colon Rectum. 2005;48(11):2010–24. https://doi.org/10.1007/s10350-005-0138-1.CrossRefPubMed

19.

Malik AH, East JE, Buchanan GN, Kennedy RH. Endoscopic haemostasis of staple-line haemorrhage following colorectal resection. Colorectal Dis. 2008;10(6):616–8. https://doi.org/10.1111/j.1463-1318.2007.01459.x.CrossRefPubMed

20.

Cirocco WC, Golub RW. Endoscopic treatment of postoperative hemorrhage from a stapled colorectal anastomosis. Am Surg. 1995;61(5):460–3.PubMed

Title: Anastomotic bleeding following ileocolic end-to-side anastomosis using a circular stapler: incidence and risk factors
Authors: Tatsuki Noguchi
Shigenobu Emoto
Kazushige Kawai
Takeshi Nishikawa
Yasutaka Shuno
Kazuhito Sasaki
Manabu Kaneko
Koji Murono
Hiroaki Ishii
Hirofumi Sonoda
Toshiaki Tanaka
Keisuke Hata
Hiroaki Nozawa
Soichiro Ishihara
Publication date: 01-11-2020
Publisher: Springer Singapore
Keywords: Colectomy
Colectomy
Published in: Surgery Today / Issue 11/2020
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI: https://doi.org/10.1007/s00595-020-02022-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Anastomotic bleeding following ileocolic end-to-side anastomosis using a circular stapler: incidence and risk factors

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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