title: Incidence and management of anastomotic bleeding after ileocolic anastomosis.
abstract: OBJECTIVE
  Ileocolic anastomosis is performed using a stapled or manual technique, but with either there is a risk of bleeding from the suture line. The aim of this study was to analyse, retrospectively, bleeding after different anastomotic techniques.
  
  
  METHODS
  Patients having elective right colectomy were divided, according to the type of ileocolic anastomosis, into Group 1 (circular, double-stapled, end-to-side), Group 2 (linear-stapled, side-to-side) and Group 3 (handsewn, side-to-side). Postoperative lower gastrointestinal bleeding (LGIB) was studied in the three groups. Uni- and multivariate analysis was performed to study risk factors for LGIB and the need for postoperative allogeneic blood transfusion.
  
  
  RESULTS
  Three-hundred and fifty patients were included: 174 in Group 1, 59 in Group 2 and 117 in Group 3. The postoperative LGIB rate was 4.9% and occurred exclusively in Group 1. Five patients had severe anastomotic bleeding. Postoperative blood transfusion was indicated in Groups 1, 2 and 3 in 19.0%, 5.1% and 13.7% of patients. In the five patients with severe bleeding, four attempts of colonoscopic arrest were made, achieving bleeding control in one. Angiographic embolization was successful in one patient. There were no procedure-specific complications.
  
  
  CONCLUSIONS
  End-to-side, circular, double-stapling ileocolic anastomosis seems to be related to an increased incidence of anastomotic bleeding and of postoperative blood transfusion compared with patients having other techniques of ileocolic anastomosis.
authors.affiliation: Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital and IDIBELL, University of Barcelona, Barcelona, Spain.
authors.forename: T
authors.initials: T
authors.lastname: Golda
authors.forename: C
authors.initials: C
authors.lastname: Zerpa
authors.forename: E
authors.initials: E
authors.lastname: Kreisler
authors.forename: L
authors.initials: L
authors.lastname: Trenti
authors.forename: S
authors.initials: S
authors.lastname: Biondo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D000925:Anticoagulants / Q000009:adverse effects; D001803:Blood Transfusion; D003082:Colectomy; D003106:Colon / Q000601:surgery*; D003113:Colonoscopy; D004621:Embolization, Therapeutic; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D013536:Suture Techniques / Q000009:adverse effects*; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D014812:Vitamin K
keywords: Right colectomy; anastomotic complication; gastrointestinal bleeding