Common side closure type, but not stapler brand or oversewing, influences side-to-side anastomotic leak rates.
BACKGROUND
Anastomotic leak (AL) increases costs and cancer recurrence. Studies show decreased AL with side-to-side stapled anastomosis (SSA), but none identify risk factors within SSAs. We hypothesized that stapler characteristics and closure technique of the common enterotomy affect AL rates.


METHODS
Retrospective review of bowel SSAs was performed. Data included stapler brand, staple line oversewing, and closure method (handsewn, HC; linear stapler [Barcelona technique], BT; transverse stapler, TX). Primary endpoint was AL. Statistical analysis included Fisher's test and logistic regression.


RESULTS
463 patients were identified, 58.5% BT, 21.2% HC, and 20.3% TX. Covidien staplers comprised 74.9%, Ethicon 18.1%. There were no differences between stapler types (Covidien 5.8%, Ethicon 6.0%). However, AL rates varied by common side closure (BT 3.7% vs. TX 10.6%, p = 0.017), remaining significant on multivariate analysis.


CONCLUSIONS
Closure method of the common side impacts AL rates. Barcelona technique has fewer leaks than transverse stapled closure. Further prospective evaluation is recommended.
Department of General Surgery, Rush University Medical Center, Chicago, IL, United States. Electronic address: vidyaratna_a_fleetwood@rush.edu.
V A
VA
Fleetwood
Department of General Surgery, Rush University Medical Center, Chicago, IL, United States.
K N
KN
Gross
Department of General Surgery, Rush University Medical Center, Chicago, IL, United States.
G C
GC
Alex
Department of General Surgery, Rush University Medical Center, Chicago, IL, United States.
C S
CS
Cortina
Department of General Surgery, Rush University Medical Center, Chicago, IL, United States.
J B
JB
Smolevitz
Department of General Surgery, Rush University Medical Center, Chicago, IL, United States.
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Sarvepalli
Department of General Surgery, Rush University Medical Center, Chicago, IL, United States.
S R
SR
Bakhsh
Department of General Surgery, Rush University Medical Center, Chicago, IL, United States.
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Poirier
Department of General Surgery, Rush University Medical Center, Chicago, IL, United States.
J A
JA
Myers
Department of General Surgery, Rush University Medical Center, Chicago, IL, United States.
M A
MA
Singer
Department of General Surgery, Rush University Medical Center, Chicago, IL, United States.
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Orkin
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods*; D057868:Anastomotic Leak / Q000209:etiology*; D003920:Diabetes Mellitus / Q000453:epidemiology; D004867:Equipment Design; D005260:Female; D006801:Humans; D007422:Intestines / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D061646:Operative Time; D012189:Retrospective Studies; D012307:Risk Factors; D017792:Surgical Stapling / Q000295:instrumentation / Q000379:methods*; D055815:Young Adult
Anastomotic leak; Brand; Device; Oversewing; Side to side anastomosis; Stapler