Operator-Related Risk Factors of Anastomotic Leaks After Colorectal Surgery: An Up-to-Date

Caziuc, Alexandra; Dindelegan, George; Mironiuc, Aurel

doi:10.15386/cjmed-420

Cited by 3 publications

(2 citation statements)

References 31 publications

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“…Higher blood loss during surgery and intraoperative blood transfusion have shown adverse effects on the healing of intestinal anastomosis in experimental and clinical trials 4,6,[36][37][38][39] . In our study, surgeons from the high volume group had a statistically significant increase in blood loss during surgery.…”

Section: Discussionmentioning

confidence: 99%

Influence of individual surgeon volume on early postoperative outcomes after rectal cancer resection

et al. 2019

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Background/Aim. Surgeon-specific experience as measured by procedure volume can have a significant impact on survival of patients with rectal cancer (RC). The aim of this study was to determine whether an individual surgeon-specific volume of procedure influences early postoperative outcomes as well as to determine the strength of different groups of annual surgeon volume (ASV), as a predictor of outcomes in patients after RC resection up to 30 days postoperatively. Methods. This retrospective observational single center study involved a cohort of 546 patients of both sexes, operated for a 10-year period due to RC. Patients were divided into three groups, according to the annual volume of RC procedures of a surgeon who operated them. Seven outcomes were analyzed: the incidence of colorectal anastomotic dehiscence (CRAD), operative time, intraoperative blood loss, hospital stay, in-hospital death, the status of the circumferential resection margin (CRM) and the total mesorectal excision (TME) with number of lymph nodes, as well as some risk factors (several independent, dependent and "confusing" variables) of importance for the outcome, to explain the difference. The strength of each group of surgeons and their effect on early outcome of treatment were determined. Results. The majority of surgeons (77.7%) belonged to the low and medium ASV, which performed a slightly higher number of surgeries (281) than the high volume group. The high-volume surgeon group was associated with significantly better results in four outcomes (CRAD, operating time, CRM, TME and number of lymph nodes). Conclusion. In our surgical institution, the high volume surgeon remains an important predictor of success of the RC surgery.

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Section: Discussionmentioning

confidence: 99%

Influence of individual surgeon volume on early postoperative outcomes after rectal cancer resection

et al. 2019

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“…[14]. Kai kurie rizikos veiksniai gali būti chirurgo kontroliuojami operacijos metu: anastomozės perfuzija, netekto kraujo kiekis, chirurginė technika ir operacijos trukmė [15]. Svarbu rasti būdų, kaip sumažinti minėtų rizikos veiksnių poveikį anastomozės nesandarumui atsirasti.…”

Section: Ligoniai Ir Metodaiunclassified

Pooperacinių storosios žarnos anastomozių nesandarumo gydymo kaštų analizė

Poškus

Mikėnas

Danys

2018

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[straipsnis ir santrauka lietuvių kalba; santrauka anglų kalba] Įvadas. Anastomozės nesandarumas yra viena iš pavojingiausių komplikacijų, kylančių po storosios žarnos rezekcinių operacijų. Dėl šios pooperaciniu laikotarpiu pasireiškiančios komplikacijos pacientams didėja sergamumo ir mirtingumo rizika. Be komplikacijų ir pacientui sukeliamų klinikinių simptomų, anastomozės nesandarumas yra didelė finansinė našta ligoninei dėl atliekamų pakartotinių operacijų, didelio lovadienių skaičiaus, instrumentinių tyrimų ir kitų veiksnių, susijusių su anastomozės nesandarumo gydymu.Ligoniai ir metodai. Atliktas retrospektyvinis tyrimas. Tirti 39 pacientai, kuriems pooperaciniu laikotarpiu po storosios žarnos rezekcinės operacijos pasireiškė anastomozės nesandarumas. Analizuoti duomenys rinkti iš ligos istorijų protokolų ir naudojantis ligoninės elektronine sistema. Gydymo išlaidos skaičiuotos bendradarbiaujant su Vilniaus universiteto ligoninės Santaros klinikų Ekonomikos skyriumi. Anastomozės nesandarumo gydymo kaina lyginta su įprasto nekomplikuoto gydymo kaina ir su lėšomis, skirtomis pacientams gydyti, iš Valstybinės ligonių kasos.Rezultatai. Analizuoti 26 vyrų (66,7 %) ir 13 moterų (33,3 %) duomenys. Tiriamųjų amžiaus vidurkis – 69,5±13,6 metų, kūno masės indekso (KMI) vidurkis – 28,3. Ligoninės išlaidos šių pacientų anastomozės nesandarumui gydyti buvo didesnės negu lėšos, skirtos iš Valstybinės ligonių kasos (8 373,2±3 709,27 Eur vs. 4 097,1±1254,66 Eur) (p < 0,001). Ligonių, kuriems nustatytas anastomozės nesandarumas, gydymas kainavo keturis kartus daugiau negu nekomplikuotas poopercinis gydymas (8 373,2±3 709,27 Eur vs. 2 041,51±146,53 Eur), truko ilgiau (25,7±18,48 dienų vs. 7,5 dienų) ir buvo dešimt kartų nuostolingesnis (4 275,6±2 967,84 Eur vs. 389,0±146,08 Eur). 2014–2016 m. bendras ligoninės nuostolis, gydant anastomozės nesandarumą, siekė 166 769,74 Eur. Gydymo metu mirė 10 (25,6 %) tiriamųjų.Išvados. Storosios žarnos anastomozių nesandarumo gydymas kelia ligoninei didelę finansinę naštą. Būtina ieškoti sprendimų šiai problemai spręsti.

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Use of the Staple Line Reinforcement Tool to Reduce the Rate and Completely Avoid Anastomotic Leakage in Functional End-to-End Anastomosis

Hirose,

Hada,

Nishida

et al. 2024

Cureus

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Background In our hospital, anastomotic leakage (AL) is observed in approximately 2% of functional end-to-end anastomosis (FEEA) cases annually. It is also usually observed at the staple line of the entry hole closure in several reoperation cases. This study aimed to investigate whether AL would occur in FEEA using a new staple line reinforcement tool, ECHELON ENDOPATH ® Staple Line Reinforcement (SLR) (Ethicon, Raritan, NJ, USA). Methods A total of 380 patients (400 anastomoses performed from September 2021, when SLR use began, to the end of February 2024) were compared retrospectively, with a total of 459 patients (469 anastomoses performed from April 2019 to August 2021), the same period before SLR was initiated. In the SLR group, ECHELON FLEX ® (Ethicon) 60 mm and GST ® system (Ethicon) cartridges were used as stapling devices. A p-value of <0.05 was considered statistically significant. Results No AL was observed in the SLR group, with a significant difference between the SLR and non-SLR groups (p=0.0021). By anastomotic organ, the AL rate significantly decreased for small intestine-colon anastomosis (p=0.023), but there was no significant difference in small intestine-small intestine anastomosis (p=0.061) or colon-colon anastomosis (p=0.35) between groups. Conclusion Reinforcing the staple line using SLR in FEEA may reduce the AL rate. Although AL has not been observed, we will continue to investigate its causes should it occur in the future.

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Operator-Related Risk Factors of Anastomotic Leaks After Colorectal Surgery: An Up-to-Date

Cited by 3 publications

References 31 publications

Influence of individual surgeon volume on early postoperative outcomes after rectal cancer resection

Influence of individual surgeon volume on early postoperative outcomes after rectal cancer resection

Pooperacinių storosios žarnos anastomozių nesandarumo gydymo kaštų analizė

Use of the Staple Line Reinforcement Tool to Reduce the Rate and Completely Avoid Anastomotic Leakage in Functional End-to-End Anastomosis

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