Common side closure type, but not stapler brand or oversewing, influences side-to-side anastomotic leak rates

The impact of stapling technique and surgeon specialism on anastomotic failure after right‐sided colorectal resection: an international multicentre, prospective audit

“…One single‐centre study has suggested a possible benefit from oversewing of ileocolic anastomoses and ileostomy closures , although the study was retrospective and there was no comparison group presented. A recent retrospective study also identified no benefit from staple line oversewing and two well‐conducted trials of bio‐absorbable staple line reinforcement adjuncts also found no benefit in intestinal anastomoses . Our findings do not support the practice of oversewing of the anastomotic staple line to prevent anastomotic leak.…”

“…There were no differences in risk factors between the groups to suggest selection bias, although there was an increased proportion of malignant disease (nonsignificant) in the noncutting apical stapler group. Whilst multiple randomized trials have explored outcomes after stapled or handsewn anastomoses in right colonic surgery , only one retrospective study has examined the intricacies of stapler technique and the use of a cutting vs noncutting stapler for apical closure after a side‐to‐side stapled anastomosis . This earlier study included small bowel, ileocolic and colocolic anastomoses in both elective and emergency settings, resulting in a very heterogeneous patient cohort, and found that closure of the apical enterotomy with a cutting stapler had a lower anastomotic leak rate compared with a noncutting stapler (3.7% vs 10.6%, P = 0.017).…”

“…In additional, stapler device manufacturers do not recommend routinely oversewing the apical staple line, as this may reduce anastomotic tissue perfusion. Despite this, half of surgeons across Europe oversew side‐to‐side intestinal anastomotic staple lines .…”