Schuster S*, Aigner C, Raab S, Rossetti L, Szabo K, Poljo A, Huber L and Shamiyeh A
Department of General and Visceral Surgery, Kepler University Clinic (KUK), Med Campus III in Linz, AustriaFulltext PDF
Introduction: The right-sided hemicolectomy is a regularly performed abdominal surgery worldwide. Reasons for possible complications and the technique of the anastomosis, especially the occurrence of Anastomotic Leakage (AL), are still discussed controversially in the literature and considered a life threatening complication. Therefore, we analyzed our data retrospectively with special focus on anastomosis related complications. Material and Methods: All patients who underwent a right hemicolectomy between 2010 and 2019 at the Department of General and Visceral Surgery at the Kepler University Clinic (KUK) – Med Campus III in Linz, Austria have been analyzed retrospectively. The following parameters were documented: Sex, age, BMI, indication for surgery, surgical approach, postoperative morbidity and mortality, technique of anastomosis, occurrence of AL, need for ileostomy, intraoperative peritonitis, postoperative revisional surgery, postoperative food intake, intraoperative peritonitis, corticosteroid intake at time of surgery, pain catheter, highest postoperative CRP level, lymph node stage (N) and the number of retrieved lymph nodes (in general and positive ones). Results: Of 641 patients, 263 (41.0%) had laparoscopic resection (7.2% conversion rate) and 378 (59.0%) underwent open surgery. 239 (37.3%) of all patients got a hand-sewn anastomosis, whereas 375 (58.5%) received stapled ones which were mostly created extra-corporally. 26 (4.06%) patients got a terminal ileostomy and were therefore excluded from other calculations, resulting in a final patient collective of n=615. The overall leakage rate was 3.9% (n=24) with a postoperative mortality of 16.7% (4 of 24 patients with leakage, p=0.015*). The occurrence of an AL was followed by average 1.92 (from 1 up to 8) revisional surgeries (p<0.001**) between the 8th and 9th postoperative day. Eight (33.3%) of the leaking anastomosis were hand-sewn and 16 (66.7%) were stapled in acute (45.8%) or elective surgeries (54.2%). Conclusion: The event of AL after right-sided hemicolectomy was rarely occurring and independent of the surgical approach as well as the anastomosis technique. Statistically significant differences in patients with leaks were found in the number of revisional surgeries, the ASA score, the postoperative 30-day morbidity and mortality, the length of the postoperative stay in hospital, highest postoperative CRP level and number of retrieved positive lymph nodes.
Schuster S, Aigner C, Raab S, Rossetti L, Szabo K, Poljo A, et al. Outcome after Right Hemicolectomy with Special Focus on Anastomotic Leakage – A Retrospective Analysis on 641 Patients. Clin Surg. 2021; 6: 3365..