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Published on: November 4, 2010
Reduction of anastomotic failure in laparoscopic colorectal surgery using antitraction sutures
Ralph P M Gadiot1, Michalda S Dunker, Amir Mearadji
1Sint Fransiscus Gasthuis, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands. r.gadiot@sfg.nl
Background:
Anastomotic leakage is a major complication in colorectal surgery. This study investigates a new method for reducing anastomotic failure using antitraction sutures.
Methods:
In 2007, the authors began routine placement of three sutures at every one-third of the circular end-to-end anastomosis to reduce traction. Before the start of the new protocol, 76 patients received laparoscopic colorectal left sided surgery, 21 (28%) of whom received a defunctioning stoma. After the start of the new protocol, 77 patients received laparoscopic colorectal surgery, 6 (8%) of whom received a defunctioning stoma.
Results:
Placement of a defunctioning stoma was significantly reduced (n = 21 vs. 6; P = 0.01). Only one patient (1%) in the sutured group experienced anastomotic leakage compared with six patients in the control group (P = 0.025). Other anastomosis-related complications during the follow-up period, including anastomotic stenosis and intraabdominal abscess, occurred more frequently in the control group, although the difference did not reach significance.
Conclusion:
The use of antitraction sutures to support the anastomosis seems to reduce the occurrence of anastomotic leakage in laparoscopic left colorectal surgery. A prospective randomized trial is necessary to prove the decreasing effect of antitraction sutures on anastomotic leakage as well as the major decreasing effect on the necessity of placement of defunctioning stomas.
