• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2023 Scientific Session Call For Abstracts
      • 2023 Emerging Technology Call For Abstracts
    • SAGES 2021 Annual Meeting
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • SAGES 2021
      • SAGES 2020
      • SAGES 2019
      • SAGES 2018
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Video Based Assessments (VBA)
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Store
    • SAGES Logo Products
    • “Unofficial” Logo Products
  • Log In

A new composite program to eliminate anastomotic leakage in laparoscopic colorectal surgery

Hitoshi Idani, MD, FACS, Hiroyuki Araki, MD, Soichiro Miyake, MD, Hisanobu Miyoshi, MD, Kazutaka Takahashi, MD, Toshihiko Fujita, MD, Naoki Mimura, MD, Toshihiro Ogawa, MD, Yasuhiro Komatsu, MD, Hiroaki Inoue, MD, Kenji Yamaguchi, MD, Hijiri Matsumoto, MD, Yasuo Nagai, MD, Masao Harano, MD, Yasutomo Ojima, MD, Noriaki Tokumoto, MD, Hiroyoshi Matsukawa, MD, Takashi Kanazawa, MD, Yasuhiro Choda, MD, Daisuke Sato, MD, Michihiro Ishida, MD, Shigehiro Shiozaki, MD, Masazumi Okajima, MD, FACS, Motoki Ninomiya, MD. Department of Surgery Hiroshima City Hospital

Background: Anastomotic leakage (AL) is still a crucial matter in colorectal surgery. We have introduced a new program to eliminate AL in laparoscopic colorectal surgery and evaluated the outcome.

Methods: Our program consisted of basic care and surgical protocol. The former included smoking cessation, control of blood sugar and nutrition, lactobacillus preparation, disuse of NSAIDS and continuous use of aspirin. The latter included surgery with meticulous hemostasis, anastomosis by linear stapler in colectomy and double stapling technique in anterior resection (AR) with reinforcement sutures at all staple on staple site. Especially in AR, the left colic artery was reserved as long as possible, the rectum was resected  with one stapler or two (planned) in which staple on staple site was resected by circular stapler and anastomosis was confirmed by intraoperative colonoscopy. Pelvic drain was used and trans-rectal decompression tube was used if needed. From January 2014 to August 2015, 91 out of 226 patients who underwent laparoscopic colorectal surgery were enrolled in this program. The occurrence of AL in every grade of Clavien Dindo classification (CDC) was evaluated separately in colon surgery and in AR.

Results: There was no leakage in every grade of CDC in 61 colon surgery. Patients underwent AR consisted of 21 men and 10 women with a mean age of 64.3 years. Body mass index was 23.3.  Location of the tumor was Rs: 5/Ra: 14/Rb: 12. Comorbidities were as follows; diabetes mellitus: 4, aspirin use for coronary stent: 4, warfarin use: 2, chronic renal failure with hemodialysis: 1. High AR, low AR and super low AR were performed on 5, 24 and 2 patients, respectively. Operation time and blood loss were 223 min and 32.8g, respectively. The number of stapler used for rectal resection was one: 24, two: 6, three: 1. Bilateral reinforcement sutures were achieved laparoscopically in 28 (90.3%) patients. Diverting ileostomy was added on 4 patients. Pelvic drain was used in all patients, however, trans-anal tube was never used. The distance from anal verge to the anastomosis was 5.9±1.8 cm. Mean postoperative stay was 10.4 days and there was no leakage in every grade of CDC, whereas there were 6 leakages (grade 2/3: 4/2) in patients who have not enrolled in this program.

Conclusion: Our new composite program can minimize the risk of anastomotic leakage in laparoscopic colorectal surgery. Reinforcement sutures may play an important role to improve resistant pressure at the anastomosis.

133

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2016 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Surgery is Safer with Vaccination 1

Addressing Religious Concerns About COVID-19 Vaccine

This may be a difficult subject matter for you and your patient to talk about.  Be assured, all major organized religious groups encourage and recommend the COVID-19 vaccine. Listed below are references and websites you can direct your patient towards to help them make an informed decision with regards to their religious concerns against the […]

SAGES Statement on AAPI Violence

The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) stands in solidarity with the Asian American and Pacific Islander (AAPI) community. In the summer of 2020, SAGES released a statement condemning the violence, racism, and hatred toward the Black community in the wake of George Floyd and Breonna Taylor’s murders. It is with great sorrow […]

Free SAGES Webinar: Lessons from COVID on Living and Thriving as Surgeons

SAGES recognizes that the COVID-19 pandemic has had a big impact on surgical practice and in surgeon wellness. SAGES’ Reimagining the Practice of Surgery Taskforce will present “Finding the Opportunities: Lessons from COVID and How We Live and Thrive as Surgeons”  to look at ways in which innovative leadership at various levels may help transform […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
[email protected]
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2022 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2022 Society of American Gastrointestinal and Endoscopic Surgeons