739 cases in 9 yrs of experience using SEAMGUARD (staple line reinforcement) in laparoscopic CRS at TX Endosurgery Institute

Morris E Franklin Jr., MD, FACS, Miguel A Hernandez, MD, Jeffrey L Glass, MD, FACS, Bryson Nicholson, MD, Ekong Uffort, MD. Texas Endosurgery Institute

Background: Anastomotic leak, bleeding, and stricture are recognized complications with increase morbidity and mortality. The frequency of anastomoses leakage rages from 1% to 24%. The leakage rate is generally higher for rectal anastomosis (12% – 19%) than for colonic anastomoses (11%)(1,2). During laparoscopic colorectal surgery, the anastomosis may be created intra or extracorporeally. The aim of this study is to describe our experience, quality of anastomosis, and the low rate of complications in laparoscopic colorectal anastomosis procedures with SeamguardR , and how it improves the outcomes.

Methods: Retrospective study and collected data of 739 consecutive patients who underwent laparoscopic colorectal resection and primary anastomosis using SEAMGUARD since January 2006 to September 2015 were reviewed.

Results: There were no differences in patients’ demographics, surgical procedure, and anesthesia used. Complete data was available for 739 patients; 371 (50.3%) female, 368 (49.7%) male. Procedures included were: 305(41%) right hemicolectomy, 222 (30%) sigmoidectomy, 144 (19.5%) low anterior resection, 29 (4%) subtotal colectomy, 28 (3.8%) left hemicolectomy, and 11 (1.5%) transverse solon resection. The diagnoses of the patients were: colorectal cancer 290 (39.5%), diverticulitis 168 (23%), polyps 128 (17.7%), Crohn’s disease 11 (1.5%), dysmotility 4 (0.5%), rectal prolapse 2 (0.3%), ulcerative colitis 12 (1.7%), fistula 22(3%), ischemic colitis 11 (1.5%), perforation 28 (3.8%), volvulus 14 (1.9%), and obstruction 49 (6.7%). Median follow-up was 7 months (range 1-13). Total intracorporeal anastomosis was done in 532 (72%), and hand assisted anastomosis in 207 (28%). There were 3 (0.4%) anastomotic leak detected and treated intraoperativelly. No strictures, and no bleeding in our early postoperative follow-up period.

Conclusion: The use of SEAMGUARD at the anastomosis site is feasible and safe, and seems to show a low rate of stenosis, leaks, bleeding, and better quality of anastomosis.