title: Renewed assessment of the stapled anastomosis with the increasing role of laparoscopic colectomy for colon cancer.
abstract: BACKGROUND
  Stapled gastrointestinal anastomosis has gained wide adoption among the surgical community for its ease, speed, and its applicability in laparoscopic surgery. Over the last decade, with the increase in laparoscopic techniques in colon surgery, anastomotic stapling has become the technique of choice for colon cancer surgery at our center. This abstract assesses whether the increasing adoption of anastomotic stapling affected the rate of anastomotic leaks and duration of surgery.
  
  
  METHODS
  All patients surgically treated for colon cancer with a primary bowel anastomosis from 2004 through 2011 were included (n = 998). Duration of stay, surgery, and postoperative complication rates was compared between hand-sewn and stapled anastomosis.
  
  
  RESULTS
  The number of stapled anastomoses grew significantly from 45.8% in 2004-2007 to 80.3% in 2008-2011 (p < 0.001), and an increasing portion of those is performed in laparoscopic procedures (29.8 to 43.3%; p = 0.01). Surgeries using stapled anastomosis initially took longer, but a decreasing trend (2004-2007: 147.5 min to 2007-2011: 124 min; p < 0.001) along with an increasing duration in hand-sewn surgeries (94-118.5 min; p < 0.01) meant stapled procedures became shorter than hand-sewn procedures by 2009. Complication rates did not differ significantly between groups, with stapled anastomoses having lower percentages of anastomotic leaks (1.6 vs. 2.4%; p = 0.38). By the second half of our research period, the median admission for patients with stapled anastomoses was two days shorter (4 vs. 6 days; p < 0.001), independently of the chosen approach.
  
  
  CONCLUSIONS
  Stapled anastomoses did not increase anastomotic leak rates. If anything, leak rates appeared slightly lower. In addition, stapled anastomoses significantly shortened operation duration. With the benefit of being a tool that facilitates minimally invasive surgery, it is a safe way to improve efficiency, reduce costs, and promote faster and better recovery.
authors.affiliation: Division of General and Gastrointestinal Surgery, Massachusetts General Hospital & Harvard Medical School, 15 Parkman Street, Boston, MA, 02114, USA.
authors.forename: Ramzi
authors.initials: R
authors.lastname: Amri
authors.forename: Liliana G
authors.initials: LG
authors.lastname: Bordeianou
authors.forename: Patricia
authors.initials: P
authors.lastname: Sylla
authors.forename: David L
authors.initials: DL
authors.lastname: Berger
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D057868:Anastomotic Leak / Q000209:etiology; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D061646:Operative Time; D017792:Surgical Stapling; D013537:Sutures