3 research outputs found
Relationship between method of anastomosis and anastomotic failure after right hemicolectomy and ileo-caecal resection: an international snapshot audit
- Publication venue
- 'Wiley'
- Publication date
- 01/01/2017
- Field of study
No full textAim The anastomosis technique used following right-sided colonic
resection is widely variable and may affect patient outcome. This study
aimed to assess the association between leak and anastomosis technique
(stapled vs handsewn).
Method This was a prospective, multicentre, international audit
including patients undergoing elective or emergency right hemicolectomy
or ileo-caecal resection operations over a 2-month period in early 2015.
The primary outcome measure was the presence of anastomotic leak within
30 days of surgery, determined using a prespecified definition. Mixed
effects logistic regression models were used to assess the association
between leak and anastomosis method, adjusting for patient, disease and
operative cofactors, with centre included as a random-effect variable.
Results This study included 3208 patients, of whom 78.4\% (n = 2515)
underwent surgery for malignancy and 11.7\% (n = 375) underwent surgery
for Crohn's disease. An anastomosis was performed in 94.8\% (n = 3041)
of patients, which was handsewn in 38.9\% (n = 1183) and stapled in
61.1\% (n = 1858). Patients undergoing hand-sewn anastomosis were more
likely to be emergency admissions (20.5\% handsewn vs 12.9\% stapled)
and to undergo open surgery (54.7\% handsewn vs 36.6\% stapled). The
overall anastomotic leak rate was 8.1\% (245/3041), which was similar
following handsewn (7.4\%) and stapled (8.5\%) techniques (P = 0.3).
After adjustment for cofactors, the odds of a leak were higher for
stapled anastomosis (adjusted OR = 1.43; 95\% CI: 1.04-1.95; P = 0.03).
Conclusion Despite being used in lower-risk patients, stapled
anastomosis was associated with an increased anastomotic leak rate in
this observational study. Further research is needed to define patient
groups in whom a stapled anastomosis is safe
The First Row Transition Metal Intercalation Complexes of Some Metallic Group VA Transition Metal Dichalcogenides
- Author
- A Blanc-Soreau Le
- A Meerschaut
- A Meerschaut
- A Royer
- AH Thompson
- AM Clogston
- AR Beal
- AR Beal
- B Laar van
- B Laar van
- DA Whitney
- DE Nixon
- DJ Bradley
- F Hulliger
- F Kadijk
- FJ Salvo di
- FR Gamble
- FR Gamble
- FR Gamble
- G Lucovsky
- G Wexler
- G. R. Henning
- GV Subba Rao
- HE Barz
- HNS Lee
- J Rouxel
- J. A. Benda
- JA Benda
- JA Wilson
- JJ Hauser
- JJ Murray
- JM Berg van den
- JM Voorhoeve
- JM Voorhoeve
- JV Acrivos
- K Anzenhofer
- K Selte
- L Corliss
- L. F
- LCF Blackman
- LJ Pau van der
- M Eibschiitz
- MG Bell
- MH Maaren van
- NB Hannay
- NV Volkenstein
- PM Williams
- R. V. Kasowski
- RB Somoano
- RB Somoano
- RB Somoano
- RC Morris
- RE Grim
- RF Frindt
- RM White
- TH Geballe
- VL Ginzburg
- W. P. F. A. M. Omloo and F
- WB Clark
- WB Clark
- WY Liang
- Publication venue
- 'Springer Science and Business Media LLC'
- Publication date
- 01/01/1979
- Field of study
No full textPredictors for anastomotic leak, postoperative complications, and mortality after right colectomy for cancer: Results from an international snapshot audit
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- Publication venue
- 'Ovid Technologies (Wolters Kluwer Health)'
- Publication date
- 01/01/2020
- Field of study
No full textBackground: A right hemicolectomy is among the most commonly performed operations for colon cancer, but modern high-quality, multination data addressing the morbidity and mortality rates are lacking. Objective: This study reports the morbidity and mortality rates for right-sided colon cancer and identifies predictors for unfavorable short-term outcome after right hemicolectomy. Design: This was a snapshot observational prospective study. Setting: The study was conducted as a multicenter international study. Patients: The 2015 European Society of Coloproctology snapshot study was a prospective multicenter international series that included all patients undergoing elective or emergency right hemicolectomy or ileocecal resection over a 2-month period in early 2015. This is a subanalysis of the colon cancer cohort of patients. Main Outcome Measures: Predictors for anastomotic leak and 30-day postoperative morbidity and mortality were assessed using multivariable mixed-effect logistic regression models after variables selection with the Lasso method. Results: Of the 2515 included patients, an anastomosis was performed in 97.2% (n = 2444), handsewn in 38.5% (n = 940) and stapled in 61.5% (n = 1504) cases. The overall anastomotic leak rate was 7.4% (180/2444), 30-day morbidity was 38.0% (n = 956), and mortality was 2.6% (n = 66). Patients with anastomotic leak had a significantly increased mortality rate (10.6% vs 1.6% no-leak patients; p 65 0.001). At multivariable analysis the following variables were associated with anastomotic leak: longer duration of surgery (OR = 1.007 per min; p = 0.0037), open approach (OR = 1.9; p = 0.0037), and stapled anastomosis (OR = 1.5; p = 0.041). Limitations: This is an observational study, and therefore selection bias could be present. For this reason, a multivariable logistic regression model was performed, trying to correct possible confounding factors. Conclusions: Anastomotic leak after oncologic right hemicolectomy is a frequent complication, and it is associated with increased mortality. The key contributing surgical factors for anastomotic leak were anastomotic technique, surgical approach, and duration of surgery
