Document Detail


Outcomes for patients developing anastomotic leak after ileal pouch-anal anastomosis: does a handsewn vs. stapled anastomosis matter?
MedLine Citation:
PMID:  19333036     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Outcomes for patients developing a leak after ileal pouch-anal anastomosis have not been well investigated. This study explored whether the use of a stapled or handsewn anastomosis was associated with different outcomes when an anastomotic leak developed. PATIENTS AND METHODS: Patients were identified from a prospectively maintained pouch database. Functional outcomes regarding bowel movements, urgency, continence, and seepage were evaluated. Quality of life was assessed by the Cleveland Global Quality of Life Score. RESULTS: One hundred and seventy-five patients with anastomotic leak (141 stapled and 34 handsewn anastomosis) were identified. The two groups were similar in gender and diagnosis. Patients with handsewn anastomosis were younger (P = 0.04), had less perioperative steroid use (P = 0.05), more proximal diversion (P = 0.02), and S-pouch creation (P = 0.003). More handsewn cases had intraoperative transfusion (P = 0.04) and postoperative hemorrhage within the pelvis (P = 0.003). Long-term pouch failure was 35.3 percent in the handsewn group and 12 percent in the stapled group (P = 0.002), which was confirmed by Kaplan-Meier analysis (Log-rank P = 0.007). On multivariate analysis, leak after handsewn anastomosis was independently associated with pouch failure. Leak after stapled anastomosis carried a lower incontinence rate at 5 years (P = 0.03), while handsewn had higher nocturnal seepage rate at 3, 5, and 10 years, and most recent follow-up. Cleveland Global Quality of Life Score was comparable between the groups during follow-up. CONCLUSION: Outcomes including functional results and pouch failure rates for patients developing a leak after stapled anastomosis at ileal pouch-anal anastomosis were significantly better than outcomes for patients who develop a leak after handsewn anastomosis.
Authors:
Lei Lian; Ravi P Kiran; Feza H Remzi; Ian C Lavery; Victor W Fazio
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Diseases of the colon and rectum     Volume:  52     ISSN:  1530-0358     ISO Abbreviation:  Dis. Colon Rectum     Publication Date:  2009 Mar 
Date Detail:
Created Date:  2009-03-31     Completed Date:  2009-04-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372764     Medline TA:  Dis Colon Rectum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  387-93     Citation Subset:  IM    
Affiliation:
Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Anastomosis, Surgical / adverse effects*
Female
Humans
Male
Middle Aged
Proctocolectomy, Restorative / adverse effects*
Surgical Stapling
Suture Techniques*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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