title: Reduction of anastomotic failure in laparoscopic colorectal surgery using antitraction sutures.
abstract: BACKGROUND
  Anastomotic leakage is a major complication in colorectal surgery. This study investigates a new method for reducing anastomotic failure using antitraction sutures.
  
  
  METHODS
  In 2007, the authors began routine placement of three sutures at every one-third of the circular end-to-end anastomosis to reduce traction. Before the start of the new protocol, 76 patients received laparoscopic colorectal left sided surgery, 21 (28%) of whom received a defunctioning stoma. After the start of the new protocol, 77 patients received laparoscopic colorectal surgery, 6 (8%) of whom received a defunctioning stoma.
  
  
  RESULTS
  Placement of a defunctioning stoma was significantly reduced (n = 21 vs. 6; P = 0.01). Only one patient (1%) in the sutured group experienced anastomotic leakage compared with six patients in the control group (P = 0.025). Other anastomosis-related complications during the follow-up period, including anastomotic stenosis and intraabdominal abscess, occurred more frequently in the control group, although the difference did not reach significance.
  
  
  CONCLUSIONS
  The use of antitraction sutures to support the anastomosis seems to reduce the occurrence of anastomotic leakage in laparoscopic left colorectal surgery. A prospective randomized trial is necessary to prove the decreasing effect of antitraction sutures on anastomotic leakage as well as the major decreasing effect on the necessity of placement of defunctioning stomas.
authors.affiliation: Sint Fransiscus Gasthuis, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands. r.gadiot@sfg.nl
authors.forename: Ralph P M
authors.initials: RP
authors.lastname: Gadiot
authors.forename: Michalda S
authors.initials: MS
authors.lastname: Dunker
authors.forename: Amir
authors.initials: A
authors.lastname: Mearadji
authors.forename: Guido H H
authors.initials: GH
authors.lastname: Mannaerts
mesh_terms: D018784:Abdominal Abscess / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000517:prevention & control*; D003082:Colectomy / Q000379:methods*; D012809:Colon, Sigmoid / Q000601:surgery; D003108:Colonic Diseases / Q000601:surgery; D015179:Colorectal Neoplasms / Q000601:surgery; D003131:Combined Modality Therapy; D004867:Equipment Design; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010538:Peritonitis / Q000517:prevention & control; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000532:radiotherapy; D013314:Stress, Mechanical; D017792:Surgical Stapling; D013537:Sutures