Sami Alahmadi , David L. Berger , Christy E. Cauley , Robert N. Goldstone , William V. Kastrinakis , Marc Rubin , Hiroko Kunitake , Rocco Ricciardi , Grace C. Lee
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This study aimed to analyze potential associations between anastomotic construction, intraoperative anastomotic assessments, and clinical leak.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study comparing anastomotic techniques used in patients with colorectal cancer who underwent left-sided colorectal resections with colorectal or coloanal anastomoses at a tertiary care center. The outcomes were rates of intraoperative air leak, incomplete anastomotic donuts, and postoperative clinical leak. Univariate and multivariate analyses were performed to evaluate the potential association between anastomotic technique and intraoperative anastomotic assessments and subsequent leak.</div></div><div><h3>Results</h3><div>Among 844 patients, 27 (3.2%) had intraoperative leak, 6 (0.7%) had incomplete donuts, and 27 (3.2%) experienced clinical leak. Of note, 500 patients (59.2%) had EEAs, and 344 patients (40.7%) had NEEAs. There were no significant differences in demographics or comorbidities between groups (<em>P</em> >.05) or rates of incomplete donuts (<em>P</em> =.07). EEA was associated with significantly more intraoperative air leaks than NEEA on univariate analysis (4.9% vs 1.2%, respectively; <em>P</em> =.005) and multivariate analysis (odds ratio [OR], 3.6; 95% CI, 1.01–12.50; <em>P</em> =.049). There was no difference in postoperative clinical leak between the groups on univariate analysis (3.0% in EEA vs 3.5% in NEEA; <em>P</em> =.69) or multivariate analysis (OR, 0.97; 95% CI, 0.40–2.34; <em>P</em> =.94).</div></div><div><h3>Conclusion</h3><div>EEA is associated with higher rates of intraoperative air leak than NEEA, even after adjusting for potential confounders.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 2","pages":"Article 101899"},"PeriodicalIF":2.2000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Is end-to-end or side-to-end anastomotic configuration associated with risk of positive intraoperative air leak test in left-sided colon and rectal resections for colon and rectal cancers?\",\"authors\":\"Sami Alahmadi , David L. Berger , Christy E. Cauley , Robert N. Goldstone , William V. Kastrinakis , Marc Rubin , Hiroko Kunitake , Rocco Ricciardi , Grace C. Lee\",\"doi\":\"10.1016/j.gassur.2024.101899\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Anastomotic leak after colorectal resection is associated with morbidity, mortality, and poor bowel function. Minimal data exist on the relationship between anastomotic technique, intraoperative leak test, and subsequent clinical leak, particularly on the utility of performing end-to-end anastomosis (EEA) vs non–EEA (NEEA) to avoid postoperative leaks. This study aimed to analyze potential associations between anastomotic construction, intraoperative anastomotic assessments, and clinical leak.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study comparing anastomotic techniques used in patients with colorectal cancer who underwent left-sided colorectal resections with colorectal or coloanal anastomoses at a tertiary care center. The outcomes were rates of intraoperative air leak, incomplete anastomotic donuts, and postoperative clinical leak. Univariate and multivariate analyses were performed to evaluate the potential association between anastomotic technique and intraoperative anastomotic assessments and subsequent leak.</div></div><div><h3>Results</h3><div>Among 844 patients, 27 (3.2%) had intraoperative leak, 6 (0.7%) had incomplete donuts, and 27 (3.2%) experienced clinical leak. Of note, 500 patients (59.2%) had EEAs, and 344 patients (40.7%) had NEEAs. There were no significant differences in demographics or comorbidities between groups (<em>P</em> >.05) or rates of incomplete donuts (<em>P</em> =.07). EEA was associated with significantly more intraoperative air leaks than NEEA on univariate analysis (4.9% vs 1.2%, respectively; <em>P</em> =.005) and multivariate analysis (odds ratio [OR], 3.6; 95% CI, 1.01–12.50; <em>P</em> =.049). There was no difference in postoperative clinical leak between the groups on univariate analysis (3.0% in EEA vs 3.5% in NEEA; <em>P</em> =.69) or multivariate analysis (OR, 0.97; 95% CI, 0.40–2.34; <em>P</em> =.94).</div></div><div><h3>Conclusion</h3><div>EEA is associated with higher rates of intraoperative air leak than NEEA, even after adjusting for potential confounders.</div></div>\",\"PeriodicalId\":15893,\"journal\":{\"name\":\"Journal of Gastrointestinal Surgery\",\"volume\":\"29 2\",\"pages\":\"Article 101899\"},\"PeriodicalIF\":2.2000,\"publicationDate\":\"2025-02-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Gastrointestinal Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1091255X24007364\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Gastrointestinal Surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1091255X24007364","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：结直肠切除术后吻合口漏与发病率、死亡率和肠功能不良有关。关于吻合技术、术中泄漏试验和随后的临床泄漏之间关系的数据很少，特别是关于端到端与非端到端吻合以避免术后泄漏的效用。本研究的目的是分析吻合口构造、术中吻合口评估和临床泄漏之间的潜在关联。方法：我们对某三级保健中心的结肠直肠癌患者进行了一项回顾性队列研究，这些患者接受了左侧结肠直肠切除术并进行了结肠直肠或结肠直肠吻合术，比较了吻合技术。结果为术中漏气率、吻合口不完整甜甜圈率和术后临床漏气率。进行单因素和多因素分析以评估吻合技术与术中吻合口评估和随后的吻合口泄漏之间的潜在关联。结果/结局：844例患者中，27例（3.2%）患者术中漏气，6例（0.7%）患者甜甜圈不完整，27例（3.2%）患者临床漏气。端到端吻合500例（59.2%），非端到端吻合344例（40.7%）。两组在人口统计学、合并症和不完整甜甜圈率方面均无显著差异（p < 0.05）。单因素分析（4.9% vs 1.2%, p=0.005）和多因素分析(OR 3.6；95% CI 1.01-12.5, p= 0.049)。单因素分析（3.0% vs 3.5%, p=0.69）和多因素分析(or: 0.97；95% ci: 0.40-2.34；p = 0.94)。结论：端到端吻合术中漏气率高于非端到端吻合术，即使在调整潜在混杂因素后也是如此。
Is end-to-end or side-to-end anastomotic configuration associated with risk of positive intraoperative air leak test in left-sided colon and rectal resections for colon and rectal cancers?
Background
Anastomotic leak after colorectal resection is associated with morbidity, mortality, and poor bowel function. Minimal data exist on the relationship between anastomotic technique, intraoperative leak test, and subsequent clinical leak, particularly on the utility of performing end-to-end anastomosis (EEA) vs non–EEA (NEEA) to avoid postoperative leaks. This study aimed to analyze potential associations between anastomotic construction, intraoperative anastomotic assessments, and clinical leak.
Methods
This was a retrospective cohort study comparing anastomotic techniques used in patients with colorectal cancer who underwent left-sided colorectal resections with colorectal or coloanal anastomoses at a tertiary care center. The outcomes were rates of intraoperative air leak, incomplete anastomotic donuts, and postoperative clinical leak. Univariate and multivariate analyses were performed to evaluate the potential association between anastomotic technique and intraoperative anastomotic assessments and subsequent leak.
Results
Among 844 patients, 27 (3.2%) had intraoperative leak, 6 (0.7%) had incomplete donuts, and 27 (3.2%) experienced clinical leak. Of note, 500 patients (59.2%) had EEAs, and 344 patients (40.7%) had NEEAs. There were no significant differences in demographics or comorbidities between groups (P >.05) or rates of incomplete donuts (P =.07). EEA was associated with significantly more intraoperative air leaks than NEEA on univariate analysis (4.9% vs 1.2%, respectively; P =.005) and multivariate analysis (odds ratio [OR], 3.6; 95% CI, 1.01–12.50; P =.049). There was no difference in postoperative clinical leak between the groups on univariate analysis (3.0% in EEA vs 3.5% in NEEA; P =.69) or multivariate analysis (OR, 0.97; 95% CI, 0.40–2.34; P =.94).
Conclusion
EEA is associated with higher rates of intraoperative air leak than NEEA, even after adjusting for potential confounders.
期刊介绍：
The Journal of Gastrointestinal Surgery is a scholarly, peer-reviewed journal that updates the surgeon on the latest developments in gastrointestinal surgery. The journal includes original articles on surgery of the digestive tract; gastrointestinal images; "How I Do It" articles, subject reviews, book reports, editorial columns, the SSAT Presidential Address, articles by a guest orator, symposia, letters, results of conferences and more. This is the official publication of the Society for Surgery of the Alimentary Tract. The journal functions as an outstanding forum for continuing education in surgery and diseases of the gastrointestinal tract.
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