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  • Title: Common side closure type, but not stapler brand or oversewing, influences side-to-side anastomotic leak rates.
    Author: Fleetwood VA, Gross KN, Alex GC, Cortina CS, Smolevitz JB, Sarvepalli S, Bakhsh SR, Poirier J, Myers JA, Singer MA, Orkin BA.
    Journal: Am J Surg; 2017 Mar; 213(3):590-595. PubMed ID: 28148456.
    Abstract:
    BACKGROUND: Anastomotic leak (AL) increases costs and cancer recurrence. Studies show decreased AL with side-to-side stapled anastomosis (SSA), but none identify risk factors within SSAs. We hypothesized that stapler characteristics and closure technique of the common enterotomy affect AL rates. METHODS: Retrospective review of bowel SSAs was performed. Data included stapler brand, staple line oversewing, and closure method (handsewn, HC; linear stapler [Barcelona technique], BT; transverse stapler, TX). Primary endpoint was AL. Statistical analysis included Fisher's test and logistic regression. RESULTS: 463 patients were identified, 58.5% BT, 21.2% HC, and 20.3% TX. Covidien staplers comprised 74.9%, Ethicon 18.1%. There were no differences between stapler types (Covidien 5.8%, Ethicon 6.0%). However, AL rates varied by common side closure (BT 3.7% vs. TX 10.6%, p = 0.017), remaining significant on multivariate analysis. CONCLUSION: Closure method of the common side impacts AL rates. Barcelona technique has fewer leaks than transverse stapled closure. Further prospective evaluation is recommended.
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