Introduction: Anastomotic bleeding after a circular-stapled anastomosis in laparoscopic colon resections is a rare but extremely aggravating complication. An intraoperative endoscopic assessment of the anastomosis allows immediate evaluation regarding bleeding and possible leakage. The aim of the study was to evaluate the impact of routine intraoperative endoscopy on postoperative complications.
Methods: Since May 1999, data of all laparoscopic colon resections were collected in a prospective database. Since July 2007, we assessed every circular-stapled anastomosis with a flexible endoscope for bleeding, integrity of mucosa, and leakage. The patients with (+) and without (-) routine endoscopic assessment were compared regarding postoperative complications.
Results: Group(-) consisted of 253 patients [133 male, 120 female; mean age, 60 years (25 to 86 y)] and group(+) consisted of 85 patients [44 male, 41 female; mean age, 62 years (22 to 87 y), P=not significant] In group(-), postoperative anastomotic bleeding was diagnosed in 11 patients (4.3%) and 7 (2.8%) of these patients required endoscopic assessment and clipping. In group(+), endoscopy showed anastomotic bleeding in 5 patients (5.9%) at the time of surgery, which required clipping. Anastomotic leak was observed in 2 patients (2.4%): in one patient the circular staple line was oversewn and in the other patient anastomosis was redone. Two (2.4%) patients in group(+) had postoperative anastomotic bleeding requiring reendoscopy and clipping. The postoperative leakage rate was not significantly different in both the groups [(-)1.6%, (+)1.2%, P= not significant].
Conclusions: Intraoperative endoscopic assessment of circular-stapled anastomosis can detect early anastomotic bleeding and leakage. Although the postoperative rate of bleeding and leakage was not significantly reduced in our study, we still recommend endoscopic assessment of the circular-stapled anastomosis as a routine procedure in colorectal surgery, as the benefits outweigh the risks.
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http://dx.doi.org/10.1097/SLE.0b013e3182401e20 | DOI Listing |
Asian J Endosc Surg
January 2025
Division of Advanced Surgical Oncology, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Japan.
Background: Laparoscopy-assisted distal gastrectomy (LADG) with Billroth I (B-I) reconstruction is frequently performed for gastric cancer. However, the difference between the circular stapler technique (CS) and delta-shaped anastomosis (DA) remains unclear, especially regarding the postoperative endoscopic physiological findings.
Methods: Three hundred and one patients including 150 CS patients and 151 DA patients during LADG with B-I reconstruction between 2013 and 2019 at Saitama Medical University International Medical Center were chosen as study subjects.
Langenbecks Arch Surg
December 2024
Department of General Surgery, Huashan Hospital, Fudan University, No. 12 Middle Urumqi Road, Shanghai, 200040, China.
Background: Laparoscopic total gastrectomy (LTG) is still limited because intracorporeal oesophagojejunostomy is technically demanding and difficult in laparoscopic gastrectomy. Circular-stapled anastomosis is considered the "gold standard" method for oesophagojejunostomy in open total gastrectomy. A purse-string suture instrument is used to create a purse-string suture along the distal oesophagus as a standard technique for classic circular-stapled oesophagojejunostomy in the open total gastrectomy.
View Article and Find Full Text PDFSurg Obes Relat Dis
February 2025
Department of Surgery, University of California, San Francisco, San Francisco, California.
Background: Marginal ulcers (MU) are a significant postoperative complication following anastomotic metabolic and bariatric surgeries including Roux-en-Y gastric bypass (RYGB), one-anastomosis gastric bypass (OAGB), and biliopancreatic diversion with duodenal switch (BPD/DS). This review summarizes current knowledge on MU risk factors, screening, and prophylactic strategies.
Objectives: The goal of this review is to examine technical and patient-related risk factors for MU, assess screening strategies, and recommend prophylactic approaches to reduce MU incidence after anastomotic metabolic and bariatric surgery (MBS).
Cureus
October 2024
General Surgery, EMMS Nazareth Hospital, Nazareth, ISR.
One anastomosis gastric bypass (OAGB) is a popular bariatric procedure known for its efficacy in promoting weight loss and improving metabolic outcomes. However, the optimal anastomotic technique for OAGB remains a subject of debate. This literature review comprehensively examines the three primary anastomotic techniques - linear stapled, circular stapled, and hand-sewn - to determine their suitability for OAGB.
View Article and Find Full Text PDFBackground: Anastomotic leak rates after colorectal surgery remain high. In most left-sided colon and rectal resection surgeries, a circular stapler is utilized to create the primary bowel anastomosis. However, it remains unclear whether a relationship between circular stapler technology and anastomotic leak in left-sided colorectal surgery exists.
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