Laparosc Endosc Surg Sci . 2022; 29(4): 187-192 | DOI: 10.14744/less.2022.27037

The effect of intraoperative bleeding and staple number on anastomotic leakage in laparoscopic rectal surgery

Ertuðrul Gazi Alkurt, Mehmet Berksun Tutan
Department of General Surgery, University of Hitit Erol Olçok Training and Research Hospital, Çorum, Türkiye

INTRODUCTION: Anastomotic leakage (AL) after colorectal resection remains one of the most important com-plications with associated morbidity and mortality. The aim of this study is to investigate the number of staples used during laparoscopic rectal transection and the effect of intraoperative bleeding on AL.
METHODS: The data of 70 patients who underwent low anterior resection (LAR) for colorectal cancer between 2020 and 2022 were retrospectively analyzed. Demographic characteristics of the patients, the number of staples used, intraoperative bleeding status, and the presence of AL were examined.
RESULTS: In the group without AL, the median value was found to be two staples, with at least one stapler and at most two staples used. In the operation of patients with AL, the median value was three staples, at least three staples were used, and at most four staples were needed. A statistically significant difference was ob-served between the two groups (p<0.001). While the rate of AL was 5.56% in the group without hemorrhage, this rate was observed as 31.25% in patients with intraoperative hemorrhage. There was a statistically significant difference between the two groups (p=0.013).
DISCUSSION AND CONCLUSION: Intraoperative hemorrhage and the use of more than two staples in rectal transection in LAR have been shown to be high-risk for AL. Coloproctologists should try to reduce the number of linear staples and transect the rectum with no more than two staples.

Keywords: Anastomosis leakage, Laparoscopic colorectal cancer, Multiple stapler firings

---

Laparoskopik rektum cerrahisinde intraoperatif kanama ve stapler sayýsýnýn anastomoz kaçaðýna etkisi

Ertuðrul Gazi Alkurt, Mehmet Berksun Tutan
Hitit Üniversitesi Erol Olçok Eðitim ve Araþtýrma Hastanesi Genel Cerrahi Kliniði

GÝRÝÞ ve AMAÇ: Kolorektal rezeksiyon sonrasý anastomoz kaçaðý(AL), ilgili morbidite ve mortalite ile en önemli komplikasyonlardan biri olmaya devam etmektedir.Bu çalýþmanýn amacý laparoskopik rektal transeksiyon sýrasýnda kullanýlan stapler sayýsý ve intraoperatif kanamanýn AL üzerine etkisini araþtýrmaktýr.
YÖNTEM ve GEREÇLER: 2020-2022 yýllarý arasýnda kolorektal kanser nedeniyle LAR uygulanan 70 hastanýn verileri retrospektif olarak incelendi. Hastalarýn demografik özellikleri, kullanýlan stapler sayýsý, intraoperatif kanama durumu, AL varlýðý incelendi
BULGULAR: Anastomoz kaçaðý olmayan grupta ortanca deðer 2 stapler kullanýmý olarak bulundu, en az 1 stapler, en fazla 2 adet stapler kullanýlmýþtý, anastomoz kaçaðý görülen hastalarýn ameliyatýnda ise ortanca deðer 3 stapler olarak bulundu, en az 3 stapler kullanýlmýþ, en çok 4 staplere ihtiyaç duyulmuþtu, iki grup arasýnda istatistiksel anlamlý farklýlýk gözlemlendi (p<0,001). Hemoraji olmayan grupta anastomoz kaçaðý oraný 5,56% iken bu oran intraoperatif hemoraji görülen hastalarda 31,25% olarak gözlemlendi, iki grup arasýnda istatistiksel anlamlý farklýlýk mevcuttu (p=0,013).
TARTIÞMA ve SONUÇ: LAR’da rektal transeksiyonda intraoperatif hemorajinin ve ikiden fazla stapler kullanýmýnýn AL için yüksek riskli olduðu gösterilmiþtir.Koloproktologlar lineer zýmbalarýn sayýsýný azaltmaya çalýþmalý ve rektumu en fazla 2 staplerle transekte etmelidirler.

Anahtar Kelimeler: Laparoskopik Kolorektal Kanser, Anastomoz Kaçaðý, Çoklu Stapler Atýþlarý

---

CITE