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Intra-operative double-stapled colorectal or coloanal anastomotic complications of laparoscopic low anterior resection for rectal cancer: double-stapled anastomotic complication could result in persistent anastomotic leakage

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Abstract

Background

Laparoscopic surgery for rectal cancer is technically demanding and can be hindered by unexpected intra-operative complications. Among the various intra-operative complications, double-stapled anastomotic complications are more serious and complicated to manage. The purpose of this study is to analyze the impact of intra-operative double-stapled colorectal or coloanal anastomotic complications on short-term surgical outcomes and persistent leak, and risk factors of intra-operative double-stapled anastomotic complication.

Methods

Consecutive 363 cases of laparoscopic low anterior resection from August 2004 to November 2012 were analyzed in this study. We retrospectively reviewed intra-operative double-stapled anastomotic complications and compared patient characteristics, surgical data, post-operative clinical data, and pathological data between groups with and without intra-operative double-stapled anastomotic complications. And we analyzed risk factors for double-stapled anastomotic complication.

Results

There were 20 intra-operative double-stapled anastomotic complications among the patients (5.5 %). Operation time was longer (304.8 ± 122.0 vs. 197.1 ± 87.5 min, p = 0.001) and more diversion ileostomy were made (75 vs. 34.7 %, p < 0.001) in the group with double-stapled anastomotic complications. There were no differences in terms of surgical morbidity, conversion rate, anastomotic leakage, and hospital stay. However, there was more persistent anastomotic leakage (15 vs. 0.9 %, p = 0.003) in the group with double-stapled anastomotic complications. In univariate analysis, risk factors for double-stapled anastomotic complications were male, T4 stage lesion, and three or more stapler firings.

Conclusions

The double-stapled anastomotic complications during laparoscopic low anterior resection increased operation time and rate of diversion ileostomy. Although these factors did not adversely affect short-term surgical outcome including post-operative morbidity and anastomotic leakage, double-stapled anastomotic complications could increase persistent anastomotic leakage rate.

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Disclosures

Ji Hoon Kim, Ho Young Kim, In Kyu Lee, Seung Teak Oh, Jun Gi Kim, and Yoon Suk Lee have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, #665, Bupyung-6-dong, Bupyunggu, Incheon, 403-720, Korea

    Ji Hoon Kim, Ho Young Kim, In Kyu Lee, Seung Teak Oh, Jun Gi Kim & Yoon Suk Lee

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  1. Ji Hoon Kim
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  2. Ho Young Kim
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Correspondence to Yoon Suk Lee.

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Kim, J.H., Kim, H.Y., Lee, I.K. et al. Intra-operative double-stapled colorectal or coloanal anastomotic complications of laparoscopic low anterior resection for rectal cancer: double-stapled anastomotic complication could result in persistent anastomotic leakage. Surg Endosc 29, 3117–3124 (2015). https://doi.org/10.1007/s00464-014-4035-3

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  • DOI: https://doi.org/10.1007/s00464-014-4035-3

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