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

,

doi:10.1111/codi.14308

Cited by 36 publications

(10 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…31,32 The 2015 European Society of Coloproctology Collaborating Group (ESCCG) performed a multicentre study to determine the relationship between stapling technique and anastomotic failure for right-sided colonic resections but also failed to identify any difference in anastomotic leak rates according to the type of stapling device used to close the apical aspect. 7 The ESCCG identified, however that general surgeons had higher leak rates in comparison to colorectal surgeons. The lower leak rate in this study may be attributed to the fact that all resections included in both private and public settings were performed or supervised by a specialist colorectal surgeon.…”

Section: Discussionmentioning

confidence: 99%

“…Gender, tumour location, body mass index (BMI) and anastomotic technique are some of the many published contributory factors for anastomotic leak. 7,8 The clinical outcomes of an ES or SS anastomosis have only been investigated in two retrospective studies and one small randomized clinical trial. 4,6,9 Accordingly, we aimed to determine whether the type of extracorporeal stapled anastomosis had any impact on surgical and oncological outcomes following a laparoscopic right hemicolectomy.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A comparison of extracorporeal side to side or end to side anastomosis following a laparoscopic right hemicolectomy for colon cancer

Baqar

Wilkins

Wang

et al. 2022

ANZ Journal of Surgery

View full text Add to dashboard Cite

Background: This study aimed to investigate whether an extracorporeal side-to-side (SS) or end-to-side (ES) stapled anastomosis impacts short-term and long-term outcomes after an oncological laparoscopic right hemicolectomy. Methods: A retrospective cohort study of prospectively collected data from two Victorian tertiary referral hospitals was performed. Patients who underwent oncological resection for colorectal cancer between February 2010 and September 2020 were selected from the colorectal neoplasia database. Patients were divided into two groups depending on the type of stapled anastomosis: Group 1 (functional end-to-end/side-to-side (SS)); and Group 2 (endto-side (ES)). Primary outcomes were anastomotic leak, postoperative ileus, mortality and morbidity, length of stay post-surgery, readmission to hospital, and 30-day mortality. Results: This large case series of 1040 patients (SS = 625, ES = 415) demonstrated that the type of stapling technique impacted operative duration and postoperative ileus rates. Patients in the SS group had a faster operation of 108 min rather than 130 min in the ES group (p < 0.001). The SS group were more likely to experience a post-operative ileus (p < 0.001) with no impact on length of stay (SS, 7 days versus ES, 7 days; p = 0.14). There were no differences between the two groups with respect to lymph node yield, lymph node ratio, anastomotic leaks, return to theatre, 30-day mortality and 5-year overall survival. Discussion: The type of extracorporeal stapled anastomosis following an oncological laparoscopic right hemicolectomy has minimal impact on morbidity and survival outcomes; however, a side-to-side stapled anastomosis is more likely to be a faster operation with a higher postoperative ileus rate.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A comparison of extracorporeal side to side or end to side anastomosis following a laparoscopic right hemicolectomy for colon cancer

Baqar

Wilkins

Wang

et al. 2022

ANZ Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…There are a number of anastomotic variations including handsewn or stapled techniques and different methods of constructing stapled anastomoses. The European Society of Coloproctology (ESCP) right hemicolectomy audit of 3208 patients reported a slightly increased anastomotic leak rate from stapled anastomoses after adjustment for cofactors (OR 1.43, 95% CI 1.04–1.95, P = 0.03) [ 237 ] but no difference in the leak rate between different types of stapled anastomotic configurations [ 238 ]. However, the anastomotic leak rate for right colonic resection in ES is not insignificant [ 239 , 240 ] with a rate of 14.3% reported in the recent ESCP right hemicolectomy snapshot audit [ 237 ].…”

Section: Colorectal Cancermentioning

confidence: 99%

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

et al. 2021

View full text Add to dashboard Cite

Aim There is a requirement for an expansive and up to date review of the management of emergency colorectal conditions seen in adults. The primary objective is to provide detailed evidence‐based guidelines for the target audience of general and colorectal surgeons who are responsible for an adult population and who practise in Great Britain and Ireland. Methods Surgeons who are elected members of the Association of Coloproctology of Great Britain and Ireland Emergency Surgery Subcommittee were invited to contribute various sections to the guidelines. They were directed to produce a pathology‐based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. Each author was asked to provide a set of recommendations which were evidence‐based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after two votes were included in the guidelines. Results All aspects of care (excluding abdominal trauma) for emergency colorectal conditions have been included along with 122 recommendations for management. Conclusion These guidelines provide an up to date and evidence‐based summary of the current surgical knowledge in the management of emergency colorectal conditions and should serve as practical text for clinicians managing colorectal conditions in the emergency setting.

show abstract

“…Previous research has shown that specific risk factors that may be identified pre- and intra-operatively increase the risk of anastomotic leak after right colectomy, and variation in surgical practice can harm patient outcomes [ 1 , 5 ]. The EAGLE intervention promotes pre- and intra-operative operative risk calculation and harmonisation of surgical practice.…”

Section: Introductionmentioning

confidence: 99%

Implementation of a batched stepped wedge trial evaluating a quality improvement intervention for surgical teams to reduce anastomotic leak after right colectomy

Venn

Knowles

et al. 2023

Trials

View full text Add to dashboard Cite

Background Large-scale quality improvement interventions demand robust trial designs with flexibility for delivery in different contexts, particularly during a pandemic. We describe innovative features of a batched stepped wedge trial, ESCP sAfe Anastomosis proGramme in CoLorectal SurgEry (EAGLE), intended to reduce anastomotic leak following right colectomy, and reflect on lessons learned about the implementation of quality improvement programmes on an international scale. Methods Surgical units were recruited and randomised in batches to receive a hospital-level education intervention designed to reduce anastomotic leak, either before, during, or following data collection. All consecutive patients undergoing right colectomy were included. Online learning, patient risk stratification and an in-theatre checklist constituted the intervention. The study was powered to detect an absolute risk reduction of anastomotic leak from 8.1 to 5.6%. Statistical efficiency was optimised using an incomplete stepped wedge trial design and study batches analysed separately then meta-analysed to calculate the intervention effect. An established collaborative group helped nurture strong working relationships between units/countries and a prospectively designed process evaluation will enable evaluation of both the intervention and its implementation. Results The batched trial design allowed sequential entry of clusters, targeted research training and proved to be robust to pandemic interruptions. Staggered start times in the incomplete stepped wedge design with long lead-in times can reduce motivation and engagement and require careful administration. Conclusion EAGLE’s robust but flexible study design allowed completion of the study across globally distributed geographical locations in spite of the pandemic. The primary outcome analysed in conjunction with the process evaluation will ensure a rich understanding of the intervention and the effects of the study design. Trial registration National Institute of Health Research Clinical Research Network portfolio IRAS ID: 272,250. Health Research Authority approval 18 October 2019. ClinicalTrials.gov, identifier NCT04270721, protocol ID RG_19196.

show abstract

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

Cited by 36 publications

References 30 publications

A comparison of extracorporeal side to side or end to side anastomosis following a laparoscopic right hemicolectomy for colon cancer

A comparison of extracorporeal side to side or end to side anastomosis following a laparoscopic right hemicolectomy for colon cancer

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

Implementation of a batched stepped wedge trial evaluating a quality improvement intervention for surgical teams to reduce anastomotic leak after right colectomy

Contact Info

Product

Resources

About