pHD and physician
Mark Ellebæk
Department of Surgery OUH/Svendborg Hospital
| Project management | ||
| Project status | Open | |
| Data collection dates | ||
| Start | 01.10.2023 | |
| End | 01.10.2026 | |
Single stapling colorectal anastomosis (Singapore trial)
Short summary
The aim of the study is to investigate whether the single stapling technique (SST) in colorectal anastomosis reduces postoperative complications evaluated by Comprehensive Complication Index (CCI) when compared to the double stapling technique (DST). Secondary endpoint when comparing SST to DST are pathological findings, the systemic inflammatory response, readmission rate, time to discharge and operative time.
Rationale
When performing laparoscopic or robot-assisted high or low anterior resections, the current standard technique for the colorectal anastomosis is the double-stapled technique introduced by Griffin et al (1) in 1980. The technique has since been used widely allowing the anastomosis to be performed at a lower level than previously possible and preservation of the anal sphincter(2). The rectal stump is closed with a linear stapler and during the formation of the anastomosis a circular stapler crosses the linear staple row at least in two areas creating corners known as "dog ears", which are considered weak spots of the anastomosis and potentially increases the risk of anastomotic failure (3,4). Recently different methods such as the single stapling technique have been suggested to solve this problem. With the single stapling technique the rectal segment is closed with a purse string suture and a single circular stapler is trans anally introduced to create the anastomosis thereby avoiding intersection of stapler lines and formation of "dog ears" (5). To our knowledge, there are only few studies, which have compared the postoperative outcome of SST compared to DST. Radovanovic et al (6) and Kim HJ et al (7) both found no significant difference in anastomotic leakage rate between the two groups. They both found a significantly longer operative time for the SST group possibly due to the technique being more challenging to perform especially when performed laparoscopic. Kim HJ et al (6) also found a significantly longer distal resection margin and a lower pain score in the SST group. The pain score possibly explained by transanal extraction of the specimen. However, a recent study (8) did find a significant reduction in the anastomotic leakage rate and a lower rate of anastomotic stenosis in the SST group when compared to DST. At the department of surgery, Odense University Hospital, Svendborg, Denmark a new simple SST have been proposed (5) that can be performed both laparoscopic and robot-assisted. In this study we aim to compare the postoperative complications between SST and DST evaluated by using the Comprehensive Complications Index (CCI) (10, 11) based on the Clavien Dindo classification of postsurgical complications (12,13).
Description of the cohort
A single center retrospective study. From the Danish electronic medical record system Cosmic/EPJ we will review the patients who have had laparoscopic or robot-assisted sigmoid or rectum resection due to diverticulitis or colorectal cancer in the period of 01/01/2018 to 01/04/2023 at the department of surgery, Odense University Hospital, Svendborg, Denmark. The patients who have had the new single-stapled anastomosis technique performed will be identified and propensity matched with patients who have had the standard double-stapled technique performed in a ratio 1:2.
Collaborating researchers and departments
Department of Surgery, Odense/Svendborg Hospital