Which stapler charge is the most safe to perform ileocolic anastomoses?

Montuori, Mauro; Pinotti, Enrico; Cigagna, Luca; Pitoni, Ludovica; Pirovano, Riccardo; Mauri, Gianmaria; Ciocca, Michele Vasino

doi:10.30476/acrr.2021.92844.1116

Which stapler charge is the most safe to perform ileocolic anastomoses?

Document Type : Research/Original Article

Authors

Mauro Montuori

Enrico Pinotti

Luca Cigagna

Ludovica Pitoni

Riccardo Pirovano

Gianmaria Mauri

Michele Vasino Ciocca

Department of Surgery; Policlinico San Pietro; Ponte San Pietro (BG); Italy

10.30476/acrr.2021.92844.1116

Abstract

Introduction
Ileocolic anastomoses are made using a mechanical stapler or via hand-sewing, with many meta-analyses and reviews discussing their safety. This study compared two mechanical devices and charges, namely Echelon Flex with white charge (2.6 mm) versus EndoGIA with blue charge (3.5 mm), in isoperistaltic side-to-side ileocolic anastomosis after right hemicolectomy for cancer with similar surgical technique and postoperative management.
Methods
We made a retrospective analysis of all right hemicolectomies for malignancies performed between 1 January 2014 and 31 December 2019 in our department, comparing the mechanical device and the stapler charge used for the ileocolic isoperistaltic anastomosis.
Results
A total of 151 patients underwent right hemicolectomy for cancer. In 101 cases, the device used to perform ileocolic side-to-side isoperistaltic anastomosis was Echelon Flex with white charge (2.6 mm). In 50, the device used was EndoGIA with blue charge (3.5 mm). There were no significant differences in the baseline characteristics or complication rate (P=0.727). In particular, no differences were found in the rate of anastomotic leakage (P=0.851) or anastomotic bleeding (P=0.218). The median length of stay was ten and seven for the white and blue groups, respectively (P=0.112).
Conclusion
In our experience, mechanical ileocolic anastomosis is safe, and the two indicated staplers with the described charges do not differ in terms of anastomotic leak or bleeding.
We hope that this study will motivate further investigations in this field.

Keywords

ileocolic anastomosis

right hemicolectomy

colon cancer

stapler

stapler charge

1. Krarup P-M, Nordholm-Carstensen A, Jorgensen LN, Harling H (2014) Anastomotic Leak Increases Distant Recurrence and Long-Term Mortality After Curative Resection for Colonic Cancer. Annals of Surgery 259:930–938

2. Fabozzi M, Allieta R, Brachet Contul R, Grivon M, Millo P, Lale-Murix E, Nardi M Jr (2010) Comparison of short- and medium-term results between laparoscopically assisted and totally laparoscopic right hemicolectomy: a case-control study. Surg Endosc 24:2085–2091

3. Jurowich C, Lichthardt S, Kastner C, Haubitz I, Prock A, Filser J, Germer C-T, Wiegering A (2019) Laparoscopic versus open right hemicolectomy in colon carcinoma: A propensity score analysis of the DGAV StuDoQ|ColonCancer registry. PLoS One 14:e0218829

4. Wang G, Zhou J, Sheng W, Dong M (2017) Hand-assisted laparoscopic surgery versus laparoscopic right colectomy: a meta-analysis. World J Surg Oncol 15:215

5. Ibáñez N, Abrisqueta J, Luján J, Hernández Q, Rufete MD, Parrilla P (2019) Isoperistaltic versus antiperistaltic ileocolic anastomosis. Does it really matter? Results from a randomised clinical trial (ISOVANTI). Surg Endosc 33:2850–2857

6. Cirocchi R, Trastulli S, Farinella E, Guarino S, Desiderio J, Boselli C, Parisi A, Noya G, Slim K (2013) Intracorporeal versus extracorporeal anastomosis during laparoscopic right hemicolectomy - systematic review and meta-analysis. Surg Oncol 22:1–13