2 research outputs found
Water for food, water for life : a comprehensive assessment of water management in agriculture
- Author
- Publication venue
- 'Informa UK Limited'
- Publication date
- 01/01/2007
- Field of study
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
Aim 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