title: The small height of an anastomotic colonic doughnut is an independent risk factor of anastomotic leakage following colorectal resection: results of a prospective study on 154 consecutive cases.
abstract: OBJECTIVE
  The aim of this prospective study was to assess the influence of morphological characteristics of anastomotic doughnuts on the risk of anastomotic leakage (AL) after double-stapled colorectal anastomosis.
  
  
  METHODS
  This single-center prospective study enrolled all patients undergoing double-stapled colorectal anastomosis between December 2012 and December 2015. Maximal diameter and minimal and maximal heights and widths of both colonic and rectal doughnuts were measured by surgeons in the operating room. Their influence on the risk of AL was analyzed on uni- and multivariate models.
  
  
  RESULTS
  One hundred fifty-four patients were included; 92 (59.7%) were operated on for malignancy. Colorectal anastomoses > and <10 cm above the anal verge were performed in 96 (62.3%) and 58 (37.7%) patients, respectively. AL occurred in 17 (11.0%). The minimal height of the colonic doughnut (CD) was the only measurement significantly associated with an increased risk of AL (p = 0.026). A cutoff value of 4.5 mm for the CD determined on the ROC curve (AUC 0.685, p = 0.013) yielded the best sensitivity (61.4%) and specificity (82.4%) to predict AL. On multivariate analysis, a height of the CD <4.5 mm (OR 5.743, 95% IC 1.476-22.346, p = 0.012), malignant disease (OR 8.821, 95% IC 1.051-74.006, p = 0.045), and American Society of Anesthesiologists score >2 (OR 3.408, 95% IC 1.017-11.418, p = 0.047) were the only independent risk factors of AL.
  
  
  CONCLUSIONS
  The CD's minimal height influences the risk of AL. Its routine measurement during operation, along with other risk factors, could help to decide which patients could benefit from a diverting stoma or the creation of a new anastomosis.
authors.affiliation: Department of Digestive Surgery, Hôpital Bicêtre, University Paris Sud XI, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
authors.forename: François
authors.initials: F
authors.lastname: Cauchy
authors.affiliation: Department of Digestive Surgery, Hôpital Bicêtre, University Paris Sud XI, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
authors.forename: Solafah
authors.initials: S
authors.lastname: Abdalla
authors.affiliation: Department of Digestive Surgery, Hôpital Bicêtre, University Paris Sud XI, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Penna
authors.affiliation: Department of Digestive Surgery, Hôpital Bicêtre, University Paris Sud XI, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Angliviel
authors.affiliation: Department of Digestive Surgery, Hôpital Bicêtre, University Paris Sud XI, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Lambert
authors.affiliation: Department of Digestive Surgery, Hôpital Bicêtre, University Paris Sud XI, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Costaglioli
authors.affiliation: Department of Digestive Surgery, Hôpital Bicêtre, University Paris Sud XI, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France. antoine.brouquet@aphp.fr.
authors.forename: Antoine
authors.initials: A
authors.lastname: Brouquet
authors.affiliation: Department of Digestive Surgery, Hôpital Bicêtre, University Paris Sud XI, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Benoist
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D057868:Anastomotic Leak / Q000209:etiology*; D003106:Colon / Q000473:pathology* / Q000601:surgery*; D003107:Colorectal Surgery / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Anastomotic doughnuts; Anastomotic leakage; Colorectal surgery; Mechanical colorectal anastomosis