Anastomotic leak after manual circular stapled left-sided bowel surgery: analysis of technology-, disease-, and patient-related factors
Authors:   European Society of Coloproctology (ESCP) Circular Stapled Anastomosis Working Group and 2017 European Society of Coloproctology (ESCP) Collaborating Group, Tong C , Jamous N , Schmitz N-D , Szwarcensztein K , Morton DG , Pinkney TD , El-Hussuna A , Battersby N , Bhangu A , Blackwell S , Buchs N , Chaudhri S , Dardanov D , Dulskas A , El-Hussuna A , Frasson M , Gallo G , Glasbey J , Keatley J , Kelly M , Knowles C , Li YE , McCourt V , Minaya-Bravo A , Neary P , Negoi I , Nepogodiev D , Pata F , Pellino G , Poskus T , Sanchez-Guillen L , Singh B , Sivrikoz E , van Ramshorst G , Zmora O , Pinkney TD , Perry R , Magill EL , Keatley J , Tong C , Ahmed SE , Abdalkoddus M , Abelevich A , Abraham S , Abraham-Nordling M , Achkasov SI , Adamina M , Agalar C , Agalar F , Agarwal T , Agcaoglu O , Agresta F , Ahmad G , Ainkov A , Aiupov R , Aledo VS , Aleksic A , Aleotti F , Alias D , Allison AS , Alonso A , Alonso S , Alós R , Altinel Y , Alvarez-Gallego M , Amorim E , Anania G , Andreev PS , Andrejevic P , Andriola V , Antonacci N , Antos F , Anwer M , Aonzo P , Arenal JJ , Arencibia B , Argeny S , Arnold SJ , Arolfo S , Artioukh DY , Ashraf MA , Aslam MI , Asteria CR , Atif M , Avital S , Bacchion M , Bach SM , Balestri R , Balfour A , Balik E , Baloyiannis I , Banipal GS , Baral JEM , Barišić B , Bartella I , Barugola G , Bass GA , Bedford MR , Bedzhanyan A , Belli A , Beltrán de Heredia J , Bemelman WA , Benčurik V , Benevento A , Bergkvist DJ , Bernal-Sprekelsen JC , Besznyák I , Bettencourt V , Beveridge AJ , Bhan C , Bilali S , Bilali V , Binboga E , Bintintan V , Birindelli A , Birsan T , Blanco-Antona F , Blom RLGM , Boerma EG , Bogdan M , Boland MZ , Bondeven P , Bondurri A , Broadhurst J , Brown SA , Buccianti P , Buchs NC , Buchwald P , Bugra D , Bursics A , Burton HLE , Buskens CJ , Bustamante Recuenco C , Cagigas-Fernandez C , Calero-Lillo A , Calu V , Camps I , Canda AE , Canning L , Cantafio S , Carpelan A , Carrillo Lopez MJ , Carvas JM , Carvello M , Castellvi J , Castillo J , Castillo-Diego J , Cavenaile V , Cayetano Paniagua L , Ceccotti AA , Cervera-Aldama J , Chabok A , Chandrasinghe PC , Chandratreya N , Chaudhri SS , Chaudhry ZU , Chirletti P , Chi-Yong Ngu J , Chouliaras C , Chowdhary M , Chowdri NA , Christiano AB , Christiansen P , Citores MA , Ciubotaru C , Ciuce C , Clemente N , Clerc D , Codina-Cazador A , Colak E , Colao García L , Coletta D , Colombo F , Connelly TM , Cornaglia S , Corte Real J , Costa Pereira J , Costa S , Cotte E , Courtney ED , Coveney AP , Crapa P , Cristian DA , Cuadrado M , Cuinas K , Cuk MV , Cuk VV , Cunha MF , Curinga R , Curtis N , Dainius E , d'Alessandro A , Dalton RSJ , Daniels IR , Dardanov D , Dauser B , Davydova O , De Andrés-Asenjo B , de Graaf EJR , De la Portilla F , de Lacy FB , De Laspra ECD , Defoort B , Dehli T , Del Prete L , Delrio P , Demirbas S , Demirkiran A , Den Boer FC , Di Saverio S , Diego A , Dieguez B , Diez-Alonso M , Dimitrijevic I , Dimitrios B , Dimitriou N , Dindelegan G , Dindyal S , Domingos H , Doornebosch PG , Dorot S , Draga M , Drami I , Dulskas A , Dzulkarnaen Zakaria A , Echazarreta-Gallego E , Edden Y , Egenvall M , Eismontas V , El Nakeeb A , El Sorogy M , Elfike H , Elgeidie A , El-Hussuna A , Elía Guedea M , Ellul S , El-Masry S , Elmore U , Emile SH , Enciu O , Enriquez-Navascues JM , Epstein JC , Escolà Ripoll D , Espina B , Espin-Basany E , Estévez Diz AM , Evans MD , Farina PA , Fatayer  , Feliu F , Feo C , Feo CV , Fernando J , Feroci F , Ferreira L , Feryn T , Flor-Lorente B , Forero-Torres A , Francis N , Frasson M , Freund MR , Fróis Borges M , Frontali A , Gallardo AB , Galleano R , Gallo G , Garcia D , García Flórez LJ , García Marín JA , García Septiem J , Garcia-Cabrera AM , García-González JM , Garcia-Granero E , Garipov M , Gefen R , Gennadiy P , Gerkis S , Germain A , Germanos S , Gianotti L , Gil Santos M , Gingert C , Glehen O , Golda T , Gómez Ruiz M , Gonçalves D , González JS , Grainger J , Grama F , Grant C , Griniatsos J , Grolich T , Grosek J , Guevara-Martínez J , Gulcu B , Gupta SK , Gurjar SV , Haapaniemi S , Hamad Y , Hamid M , Hardt J , Harries RL , Harris GJC , Harsanyi L , Hayes J , Hendriks ER , Herbst F , Hermann N , Heuberger A , Hompes R , Hrora A , Hübner M , Huhtinen H , Hunt L , Hyöty M , Ibañez N , Ignjatovic D , Ilkanich A , Inama M , Infantino MS , Iqbal MR , Isik A , Isik O , Ismaiel M , Ivanovich SO , Jadhav V , Jajtner D , Jiménez Carneros V , Jimenez-Rodriguez RM , Jotautas V , Jukka K , Juloski J , Jung B , Kara Y , Karabacak U , Karachun A , Karagul S , Kassai M , Katorkin Sergei E , Katsaounis D , Katsoulis IE , Kelly ME , Kenjić B , Keogh-Bootland S , Khasan D , Khazov A , Kho SH , Khrykov GN , Kivelä AJ , Kjaer MD , Knight JS , Kocián P , Koëter T , Konsten JLM , Korček J , Korkolis D , Korsgen S , Kostić IS , Krarup PM , Krastev P , Krdzic I , Kreisler Moreno E , Krivokapic Z , Krones CJ , Kršul D , Kumar Kaul N , La Torre F , Lahodzich N , Lai CW , Laina JLB , Lakkis Z , Lamas S , Lange CP , Lauretta A , Lee KA , Lefèvre J , Lehtonen T , Leo CA , Leong KJ , Lepistö A , Licari L , Lizdenis P , Loftås P , Longhi M , Lopez-Dominguez J , López-Fernández J , Lovén H , Lozoya Trujillo R , Lunin R , Luzzi AP , Lydrup ML , Lykke J , Maderuelo-Garcia VM , Madsboell T , Madsen AH , Maffioli A , Majbar MA , Makhmudov A , Makhmudov D , Malik KI , Malik SS , Mamedli ZZ , Manatakis DK , Mankotia R , Maria J , Mariani NM , Marimuthu K , Marinello F , Marino F , Marom G , Maroni N , Maroulis I , Marsanic P , Marsman HA , Martí-Gallostra M , Martin ST , Martinez Alegre J , Martinez Manzano A , Martins R , Maslyankov S , McArdle K , McArthur DR , McFaul C , McWhirter D , Mege D , Mehraj A , Metwally MZ , Metwally IH , Millan M , Miller AS , Minaya-Bravo A , Mingoli A , Minguez Ruiz G , Minusa C , Mirshekar-Syahkal B , Mistrangelo M , Mogoanta SS , Mohamed I , Möller PH , Möller T , Molteni M , Mompart S , Monami B , Mondragon-Pritchard M , Moniz-Pereira Pedro , Montesdeoca Cabrera D , Morais M , Moran BJ , Moretto G , Morino M , Moscovici A , Muench S , Mukhtar H , Muller P , Muñoz-Duyos A , Muratore A , Muriel P , Myrelid P , Nachtergaele M , Nadav H , Nastos K , Navarro-Sánchez A , Negoi I , Nesbakken A , Nestler G , Nicholls J , Nicol D , Nikberg M , Nobre JMS , Nonner J , Norčič G , Norderval S , Norwood MGA , Nygren J , O’Brien JW , O’Connell PR , O'Kelly J , Okkabaz N , Oliveira-Cunha M , Omar GEEI , Onody P , Opocher E , Orhalmi J , Orts-Micó FJ , Ozbalci GS , Ozgen U , Ozkan BB , Ozturk E , Pace K , Padín MH , Pandey SB , Pando JA , Papaconstantinou I , Papadopoulos A , Papadopoulos G , Papp G , Paraskakis S , Parc Y , Parra Baños P , Parray FQ , Parvuletu R , Pascariello A , Pascual Migueláñez I , Pata F , Patel H , Patel PK , Paterson HM , Patrón Uriburu JC , Pattacini GC , Pavlov V , Pcolkins A , Pellicer-Franco EM , Peña Ros E , Pérez HD , Petkov P , Picarella P , Pikarsky AJ , Pisani Ceretti A , Platt E , Pletinckx P , Podda M , Popov D , Poskus E , Poskus T , Prats MC , Pravosudov I , Primo-Romaguera V , Prochazka V , Pros Ribas I , Proud D , Psaila J , Pullig F , Qureshi Jinnah MS , Rachadell Montero J , Radovanovic D , Radovanovic Z , Rahman MM , Rainho R , Rama N , Ramos D , Ramsanahie A , Rantala A , Rasulov A , Rautio T , Raymond T , Raza A , Reddy A , Refky B , Regusci L , Reissman P , Rems M , Reyes-Diaz ML , Riccardo R , Richiteanu G , Richter F , Rios A , Ris F , Rodriguez FL , Rodriguez Garcia P , Rojo Lopez JA , Romaniszyn M , Romano GM , Romero AS , Romero-Simó M , Roshan Lal A , Rossi B , Ruano Poblador A , Rubbini M , Rubio-Perez I , Ruiz H , Rullier E , Ryska O , Sabia D , Sacchi M , Saffaf N , Sakr A , Saladzinskas Z , Sales I , Salomon M , Salvans S , Samalavicius NE , Sammarco G , Sampietro GM , Samsonov D , Sanchez-Garcia JL , Sánchez-Guillén L , Sanchiz E , Šantak G , Santos Torres J , Saraceno F , Sarici IS , Sarmah PB , Savino G , Scabini S , Schafmayer C , Schiltz B , Schofield A , Scurtu R , Segalini E , Segelman J , Segura Sampedro JJ , Seicean R , Sekulic A , Selwyn D , Serrano Paz P , Shabbir J , Shaikh IA , Shalaby M , Sharma A , Shukla A , Shussman N , Siddiqui ZA , Siironen P , Sileri P , Silva-Vaz P , Simoes JF , Sinan H , Singh B , Sivins A , Skroubis G , Skrovina M , Skull AJ , Slavchev M , Slavin M , Slesser AAP , Smart CJ , Smart NJ , Smedh K , Smolarek S , Sokolov M , Sotona O , Spacca D , Spinelli A , Stanojevic G , Stearns A , Stefan S , Stift A , Stijns J , Stoyanov V , Straarup D , Strouhal R , Stubbs BM , Suero Rodríguez C , Sungurtekin U , Svagzdys S , Svastics I , Syk I , Tabares MJM , Tamelis A , Tamhane RG , Tamini N , Tamosiunas A , Tan SA , Tanis PJ , Tate SJ , Tercioti Junior V , Terzi C , Testa V , Thaha MA , Tham JC , Thavanesan N , Theodore JE , Tinoco C , Todorovic M , Tomazic A , Tomulescu V , Tonini V , Toorenvliet BR , Torkington J , Torrance A , Toscano MJ , Tóth I , Trampus S , Travaglio E , Trostchanky I , Truan N , Tulchinsky H , Turrado-Rodriguez V , Tutino R , Tzivanakis A , Tzovaras GA , Unger LW , Vaccari S , Vaizey CJ , Valero-Navarro G , Valverde Nuñez I , Van Belle K , Van Belle K , van den Berg I , van Geloven AAW , Van Loon YT , van Steensel L , Varcada M , Vardanyan AV , Varpe P , Velchuru VR , Vencius J , Venskutonis D , Vermaas M , Vertruyen M , Vicente-Ruiz M , Vignali A , Vigorita V , Vila Tura M , Vimalachandran D , Vincenti L , Viso L , Visschers RGJ , Voronin YS , Walega P , Wan Zainira WZ , Wang JH , Wang X , Wani R , Warusavitarne J , Warwick A , Wasserberg N , Weiss DJ , Westerduin E , Wheat JR , White I , Williams G , Williams GL , Wilson TR , Wilson JM , Winter D , Wolthuis AM , Wong MPK , Worsøe J , Xynos E , Yahia S , Yamamoto T , Yanishev A , Zaidi Z , Zairul Azwan MA , Zaman S , Zaránd A , Zarco A , Zawadzki M , Zelic M , Žeromskas P , Zilvetti M , Zmora O 
Published: July 2024

Abstract

Background
Anastomotic leak rates after colorectal surgery remain high. In most left-sided colon and rectal resection surgeries, a circular stapler is utilized to create the primary bowel anastomosis. However, it remains unclear whether a relationship between circular stapler technology and anastomotic leak in left-sided colorectal surgery exists.

Methods
A post-hoc analysis was conducted using a prospectively collected data set of patients from the 2017 European Society of Coloproctology snapshot audit who underwent elective left-sided resection (left hemicolectomy, sigmoid colectomy, or rectal resection) with a manual circular stapled anastomosis. Rates of anastomotic leak and unplanned intensive care unit stay in association with manual circular stapling were assessed. Patient-, disease-, geographical-, and surgeon-related factors as well as stapler brand were explored using multivariable regression models to identify predictors of adverse outcomes.

Results
Across 3305 procedures, 8.0% of patients had an anastomotic leak and 2.1% had an unplanned intensive care unit stay. Independent predictors of anastomotic leak were male sex, minimal-access surgery converted to open surgery, and anastomosis height C11 (lower third rectum) (all P &lt; 0.050). Independent predictors of unplanned intensive care unit stay were minimal-access surgery converted to open surgery and American Society of Anesthesiologists grade IV (all P &lt; 0.050). Stapler device brand was not a predictor of anastomotic leak or unplanned intensive care unit stay in multivariable regression analysis. There were no differences in rates of anastomotic leak and unplanned intensive care unit stay according to stapler head diameter, geographical region, or surgeon experience.

Conclusion
In patients undergoing left-sided bowel anastomosis, choice of manual circular stapler, in terms of manufacturer or head diameter, is not associated with rates of anastomotic leak and unplanned intensive care unit stay.