Department of General and Visceral Surgery, Friedrich-Alexander-University, Krankenhausstraße 12, Erlangen, 91054, Germany.
Department of General, Thoracic and Vascular Surgery, Greifswald University, Ferdinand-Sauerbruch-Straße, VisceralGreifswald, Germany.
Int J Colorectal Dis. 2022 Jul;37(7):1601-1609. doi: 10.1007/s00384-022-04197-5. Epub 2022 Jun 15.
Leakage of rectal anastomoses is one of the most important and feared complications in colorectal surgery. Apart from patient-specific risk factors, technical aspects may influence the occurrence of anastomotic complications. This study investigated whether using single-stapling techniques (SST) instead of the double-stapling technique (DST) for minimal-invasive rectal anastomosis is associated with a lower rate of anastomotic complications.
A retrospective review of 272 patients who received a minimally invasive stapled rectal anastomosis (3-16 cm from the anal verge) at our institution from 2015 to 2020 was performed. In 131 patients, rectal anastomosis was created by SST (SST group), while 141 patients received a rectal anastomosis with crossing stapler lines (DST group). The impact of the anastomotic technique on patient outcomes was determined by uni- and multivariate analyses.
Overall anastomotic leakage rate was 6%. Patients with SST anastomoses had a lower leakage rate than patients with DST anastomoses (3% vs. 9% in the DST group, p = 0.045). The rate of anastomotic stenosis was lower in the SST group than in the DST group (1% vs. 6%, p = 0.037). Overall morbidity and mortality did not differ between the two groups. Multivariate analysis showed that single-stapling techniques significantly reduce the risk of anastomotic leakage (OR 3.5 [1.0-11.5], p = 0.043).
The use of SST for rectal anastomosis may help to reduce anastomotic complications. This finding should be confirmed by a randomized controlled trial.
直肠吻合口漏是结直肠外科中最严重和最令人担忧的并发症之一。除了患者特有的危险因素外，技术方面也可能影响吻合口并发症的发生。本研究调查了微创直肠吻合术中使用单吻合技术（SST）代替双吻合技术（DST）是否与较低的吻合口并发症发生率相关。
回顾性分析了 2015 年至 2020 年在我院接受微创吻合直肠吻合术（距肛门缘 3-16cm）的 272 例患者。其中 131 例患者采用 SST 行直肠吻合术（SST 组），141 例患者采用交叉吻合器行直肠吻合术（DST 组）。通过单因素和多因素分析确定吻合技术对患者结局的影响。
总体吻合口漏发生率为 6%。SST 吻合组吻合口漏发生率低于 DST 吻合组（3%比 DST 组的 9%，p=0.045）。SST 组吻合口狭窄发生率低于 DST 组（1%比 DST 组的 6%，p=0.037）。两组间总发病率和死亡率无差异。多因素分析显示，单吻合技术显著降低吻合口漏的风险（OR 3.5[1.0-11.5]，p=0.043）。
直肠吻合术中使用 SST 可能有助于降低吻合口并发症。这一发现需要通过随机对照试验来证实。
