C. Shwaartz1, B. Cohen1, J. Leanza1, C. M. Divino1 1Icahn School Of Medicine At Mount Sinai,General Surgery,New York, NY, USA
Introduction:
A stapled anastomosis is commonly used during colorectal surgery for different indications. Stapled anastomoses have many advantages such as ease and speed of performance, potentially less manipulations of the anal canal, and more uniformity. The purpose of this study was to determine whether stapler size used at colorectal anastomosis affects outcomes.
Methods: This is a retrospective review of 230 patients that underwent colorectal anastomosis with the use of circular stapler between October 2013 and April 2016 at The Mount Sinai Hospital. Patients were divided into two groups based on size of the circular stapler (stapler size 25-29 mm vs 31-33 mm). Preoperative and postoperative factors including outcomes such as stricture, anastomotic leak, and functional outcomes such as the number of bowel movements per day, and incontinence were recorded and compared between the two groups. A multivariate statistical analysis was carried out to assess the associations between the stapler size and the outcomes. Patients were then called for follow up in order to assess for functional outcome using the Wexner score along with other measures.
Results:
230 patients who underwent rectal surgery were identified. 72.2% had an anastomosis performed using a 25 – 29mm circular stapler while 27.8% used a 31 – 33mm stapler. Both groups were comparable in regard to age, sex, comorbidities, smoking history, recent use of immune modulating medications or chemoradiation, procedure, indication, and the presence of bowel diversion. Those in the large stapler group were more likely to have an ASA of 3-5 vs 1-2 (P=0.05), they had a longer mean hospital stay (P=0.04) and those in the small stapler group were more likely to have a lower preoperative albumin (P=0.02). Multivariate analysis revealed that the stapler size did not predict the rate of anastomotic leak or stricture. Patients undergoing a low anterior resection with a colorectal anastomosis, compared to an anterior resection/sigmoidectomy, was significantly associated with anastomotic leaks. Additionally, the presence of bowel diversion significantly predicted stricture formation.
Regarding functional outcomes and quality of life, there was no difference found between the small and large stapler groups concerning number of bowel movements per day, presence of urgency, incontinence, pad use, clustering, need for constipating agents, any change in lifestyle reported, and mean Wexner score. Additionally, functional outcomes did not significantly differ between those asked within 1 year of bowel continuity and those who were asked after 1 year.
Conclusion:
Different stapler sizes used in rectal surgery are not associated with long term outcomes.
