title: Intra-operative double-stapled colorectal or coloanal anastomotic complications of laparoscopic low anterior resection for rectal cancer: double-stapled anastomotic complication could result in persistent anastomotic leakage.
abstract: BACKGROUND
  Laparoscopic surgery for rectal cancer is technically demanding and can be hindered by unexpected intra-operative complications. Among the various intra-operative complications, double-stapled anastomotic complications are more serious and complicated to manage. The purpose of this study is to analyze the impact of intra-operative double-stapled colorectal or coloanal anastomotic complications on short-term surgical outcomes and persistent leak, and risk factors of intra-operative double-stapled anastomotic complication.
  
  
  METHODS
  Consecutive 363 cases of laparoscopic low anterior resection from August 2004 to November 2012 were analyzed in this study. We retrospectively reviewed intra-operative double-stapled anastomotic complications and compared patient characteristics, surgical data, post-operative clinical data, and pathological data between groups with and without intra-operative double-stapled anastomotic complications. And we analyzed risk factors for double-stapled anastomotic complication.
  
  
  RESULTS
  There were 20 intra-operative double-stapled anastomotic complications among the patients (5.5 %). Operation time was longer (304.8 ± 122.0 vs. 197.1 ± 87.5 min, p = 0.001) and more diversion ileostomy were made (75 vs. 34.7 %, p < 0.001) in the group with double-stapled anastomotic complications. There were no differences in terms of surgical morbidity, conversion rate, anastomotic leakage, and hospital stay. However, there was more persistent anastomotic leakage (15 vs. 0.9 %, p = 0.003) in the group with double-stapled anastomotic complications. In univariate analysis, risk factors for double-stapled anastomotic complications were male, T4 stage lesion, and three or more stapler firings.
  
  
  CONCLUSIONS
  The double-stapled anastomotic complications during laparoscopic low anterior resection increased operation time and rate of diversion ileostomy. Although these factors did not adversely affect short-term surgical outcome including post-operative morbidity and anastomotic leakage, double-stapled anastomotic complications could increase persistent anastomotic leakage rate.
authors.affiliation: Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #665, Bupyung-6-dong, Bupyunggu, Incheon, 403-720, Korea.
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #665, Bupyung-6-dong, Bupyunggu, Incheon, 403-720, Korea.
authors.forename: Ho Young
authors.initials: HY
authors.lastname: Kim
authors.affiliation: Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #665, Bupyung-6-dong, Bupyunggu, Incheon, 403-720, Korea.
authors.forename: In Kyu
authors.initials: IK
authors.lastname: Lee
authors.affiliation: Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #665, Bupyung-6-dong, Bupyunggu, Incheon, 403-720, Korea.
authors.forename: Seung Teak
authors.initials: ST
authors.lastname: Oh
authors.affiliation: Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #665, Bupyung-6-dong, Bupyunggu, Incheon, 403-720, Korea.
authors.forename: Jun Gi
authors.initials: JG
authors.lastname: Kim
authors.affiliation: Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #665, Bupyung-6-dong, Bupyunggu, Incheon, 403-720, Korea. yslee@catholic.ac.kr.
authors.forename: Yoon Suk
authors.initials: YS
authors.lastname: Lee
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000209:etiology*; D003106:Colon / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013536:Suture Techniques / Q000009:adverse effects*; D013537:Sutures / Q000009:adverse effects
keywords: Double-stapled anastomotic complication; Intra-operative complication; Laparoscopy; Persistent leakage; Rectal cancer