Influence of stapler size used at ileal pouch-anal anastomosis on anastomotic leak, stricture, long-term functional outcomes, and quality of life.
BACKGROUND
The aim of this study was to evaluate whether stapler size used at ileal pouch-anal anastomosis (IPAA) influences outcomes.


METHODS
Data of patients undergoing stapled IPAA (1983-2007) were obtained. Differences between groups A (stapler size 28-29 mm) and B (31-33 mm) for pre- and perioperative factors, stricture, leak, quality of life (QOL), and function were compared. Associations between stapler size and stricture or leak were assessed with a multivariable Cox model.


RESULTS
Groups A (n = 1,221) and B (n = 899) had comparable age, diagnosis, body mass index (BMI), and albumin level. Group B had more males (P < .001) but fewer patients with ileostomy (P < .001). There was no significant difference in rates of leak (4.5% vs 6.2%, P = .08) or stricture (1.9% vs 2.7%, P = .1) for groups A and B. On multivariate analysis, female gender was associated with stricture, while greater BMI and male gender were associated with leak. Group A had greater urgency at 1 year and nighttime pad use at 15 years. The other determinants of function and QOL were similar.


CONCLUSIONS
There was no significant association between the size of stapler used at IPAA and long-term complications.
Kirat
Hasan T
HT
Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA. kiranp@ccf.org
Kiran
Ravi P
RP
Lian
Lei
L
Remzi
Feza H
FH
Fazio
Victor W
VW
D000328:Adult; D015331:Cohort Studies; D003108:Colonic Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*; D039021:Colonic Pouches / Q000009:adverse effects*; D003251:Constriction, Pathologic / Q000453:epidemiology; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011788:Quality of Life; D020127:Recovery of Function; D012189:Retrospective Studies; D013528:Surgical Staplers; D017792:Surgical Stapling; D016896:Treatment Outcome