title: Circumferentially oversewn inverted stapled anastomosis.
abstract: BACKGROUND
  Leak rates of over 5% following anastomoses between the ileum and colon continue to be reported in large series and are associated with substantial morbidity and with mortality rates of 10-20%. In 1994, we began performing circumferentially oversewn inverted stapled anastomoses in patients undergoing ileo-colic anastomoses or ileostomy closure. It has become increasingly apparent that this method is associated with a low risk of leakage, which we should report.
  
  
  METHODS
  The anastomotic technique described was used in all patients undergoing ileo-colic anastomosis or closure of ileostomy by surgeon 1 (1994-2015) and in all ileo-colic anastomoses by surgeon 2 (2007-2015). All patients had a widely patent anastomosis constructed by two firings of a linear cutting stapler, as previously described. Additionally, the entire staple line was carefully oversewn with interrupted, inverting 4/0 polydioxanone sutures. Anastomotic leak was defined as a patient requiring re-operation or radiological drainage.
  
  
  RESULTS
  One thousand and twelve patients underwent ileo-colic anastomosis and 685 patients underwent closure of ileostomy by surgeon 1, and 165 patients underwent ileo-colic anastomosis by surgeon 2. None of the 1862 patients required re-operation or radiological drainage for a leak (event rate 0%, 95% confidence interval 0-0.2%). However, there were three possible contained leaks treated successfully conservatively. The time taken to perform the actual anastomosis was measured in the last 30 ileo-colic resections. The median time was 42 min.
  
  
  CONCLUSIONS
  While this method may well be too slow to gain widespread adoption, we hope this report encourages increased research into finding techniques with similar low leak rates.
authors.affiliation: Department of Colorectal Surgery, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia.
authors.forename: Charbel
authors.initials: C
authors.lastname: Karam
authors.affiliation: Department of Epidemiology and Medical Statistics, The University of Notre Dame Australia, Sydney, New South Wales, Australia.
authors.forename: Sally
authors.initials: S
authors.lastname: Lord
authors.affiliation: Department of Colorectal Surgery, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia.
authors.forename: Rohan
authors.initials: R
authors.lastname: Gett
authors.affiliation: Department of Colorectal Surgery, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia.
authors.forename: Alan P
authors.initials: AP
authors.lastname: Meagher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D057868:Anastomotic Leak / Q000453:epidemiology / Q000517:prevention & control*; D003106:Colon / Q000601:surgery*; D006801:Humans; D007081:Ileostomy; D007082:Ileum / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000379:methods*; D013537:Sutures; D055815:Young Adult
keywords: anastomosis; colectomy; leak; morbidity; mortality