gms | German Medical Science

Background: Anastomotic leakage represents one of the most feared complications following colorectal resection with a relevant morbidity and mortality. There is evidence that a higher number of stapler firings for rectal division can affect the anastomotic leak rate. We present our institutional experience addressing this issue.

Materials and methods: We retrospectively analyzed 831 patients who underwent colonic and rectal resection for benign and malignant indications between January 2008 and December 2014 at the surgical department of the St. John of God Hospital, Vienna. Inclusion criteria were rectal division with linear stapling devices and construction of circular anastomosis to the rectal stump (or anal canal) with a circular stapler or a circular compression device.

Results: Four hundred one (207 female; 51.6%) patients fulfilled the aforementioned inclusion criteria. Mean age was 63.4 years (range: 18.2-94.9). Indications for the operation included diverticular disease (43.2 %), colorectal carcinoma (49.1 %), inflammatory bowel disease (5.7 %) or adenoma (2.0 %). A laparoscopic approach was carried out in 352 of 401 cases (87.8%). One, two, three or more loads of a linear stapling device for rectal division were used in 56.1%, 34.7% and 9.2%, respectively. Anastomotic leak rates among these three subgroups were 3.1% (7/225) for one magazine, 5.0% (7/139) for two magazines and 21.6% (8/37) for three or more magazines (p<0.001). The number of linear stapler firings following low rectal resection and consecutive leak rates were significantly higher (p<0.001).

Conclusion: Our data supports that the usage of multiple stapler firings to divide the rectal stump following colorectal resection has a major impact on subsequent anastomotic leak rate.