title: Higher frequency of anastomotic leakage with stapled compared to hand-sewn ileocolic anastomosis in a large population-based study.
abstract: BACKGROUND
  The stapling technique was recommended in a recent Cochrane analysis based on relatively small randomized trials between 1970 and 2009. Data from a large Swedish population-based quality register were analyzed in order to compare the leakage frequency between stapled and hand-sewn ileocolic anastomoses in colon cancer surgery.
  
  
  METHODS
  Three-thousand four-hundred and twenty-eight patients with an ileocolic anastomosis were entered in a Swedish regional quality register for colon cancer, including the type of anastomosis used. The patients were analyzed by logistic regression regarding risk for leakage, and Cox proportional hazard regression for survival associated with the technique used for anastomosis. Analyses were made for gender, age, elective or emergency surgery, duration of surgery, bleeding, cancer stage, and local radicality.
  
  
  RESULTS
  Most anastomoses were hand sewn (1,908 of 3,428, 55.7 %, p < 0.001), whereas stapling was more common among emergency cases (342 of 618, 55.3 %, p < 0.001). Clinically relevant leakage appeared in 58 patients (1.7 %), of whom 51 (87.9 %) were re-operated. Leakage was found to be more frequent after stapled anastomosis (2.4 vs. 1.2 %, p = 0.006), and in multivariate analysis, stapled anastomosis was the only risk factor (OR = 2.04 95 % CI 1.19-3.50). There was no difference in overall survival related to the technique.
  
  
  CONCLUSIONS
  Hand-sewn anastomosis is not associated with a higher leakage rate when comparing to a stapling procedure and is recommended for routine and emergency right-sided colon cancer surgery. This recommendation is based on what appears to be a lower leakage rate, similar survival and lower material cost.
authors.affiliation: Department of Surgery, Visby Hospital, Visby, Sweden, pontus.gustafsson@gotland.se.
authors.forename: Pontus
authors.initials: P
authors.lastname: Gustafsson
authors.forename: Pia
authors.initials: P
authors.lastname: Jestin
authors.forename: Ulf
authors.initials: U
authors.lastname: Gunnarsson
authors.forename: Ulrik
authors.initials: U
authors.lastname: Lindforss
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects* / Q000379:methods*; D057868:Anastomotic Leak / Q000209:etiology*; D002648:Child; D003106:Colon / Q000601:surgery*; D003110:Colonic Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012307:Risk Factors; D017792:Surgical Stapling; D013536:Suture Techniques; D055815:Young Adult