Surgical Outcomes After Colonic and Colon Rectal Anastomosis with and Without Using Buttressing Material Seam Guard R (Gore): A Retrospective Sutdy of 301 Cases By a Single Surgeon

Paravasthu S Ramanujam, MD, Kridhna P Ramanujam, BA Medical Student M, Kathleen M Griffin, RN BSN. Banner Del E Webb and Banner Boswell Medical Centers, Dept of Surgery, Sun City AZ 85351

Objective of the study: Staple line leakage at the anastomotic site is a major complication of colorectal surgery. Much of the morbidity and approximately one third of the deaths are caused by leakage of the anastomosis. Recently, anastomotic staple lines have been reinforced by absorbable reinforcement materials. This is a retrospective study to compare results of colo-rectal anastomosis with and without Seam Guard, an absorbable anastomotic buttressing material. The purpose of the study is to compare anastomotic leaks and staple line bleeding between the two groups.

Methods and proceures: A retrospective study was done of one surgeon’s experience with all colorectal surgeries from July, 2006 through December, 2009. There were 301 colo-rectal resections with anastomosis. Two hundred and thirty two resections were performed before Seam Guard buttressing material was available. Sixty nine were performed with Seam Guard staple line reinforcement. All patients were mechanically prepared with PEG solution and appropriate intravenous antibiotics for prophylaxis. the patients were discharged home when they were tolerating a regular diet and having bowel movements.

Results: Of the 301 colorectal resections, 137 (45%) were right sided, 34 (11.2%) were sigmoid colon resections, 86 (26.6%) were low anterior resections. There were 8 (2.6%) transverse colon resections and 36 (12%) ostomy closures. In the group of 232 patients where the buttressing material was not used, there were 5 anastomotic leals (2 right colon, 3 low pelvic anastomosis). In the Seam Guard group of 69 patients, there were not any anastomotic leaks. The bleeding from the GIA staple line prior to applying the final TA stapler was seen in 21 patients where buttressing material was not used. In the Seam Guard there was not any bleeding encountered from the staple line. The wound infection rate was the same in both groups about 5%. The incidence of anastomotic narrowing of the circular staple line was the same in both groups.

Conclusion: Our study showed very favorable results from using Seam Guard (W.L. Gore and associates, Flagstaff, AZ) for colorectal anastomosis. There were not any leaks when Seam Guard was used and the hemostasis was excellent. The incidence of wound infection and anastomotic narrowing were the same. A larger, randomized and double blind study needs to be done to know precisely the benefits of bioabsorbable reinforcement material.