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Anastomotic bleeding following ileocolic end-to-side anastomosis using a circular stapler: incidence and risk factors

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Abstract

Purpose

To identify the incidence of and risk factors for postoperative bleeding after ileocolic end-to-side anastomosis using a circular stapler.

Methods

We analyzed, retrospectively, the risk factors for postoperative anastomotic bleeding in patients who underwent right-sided colectomy with end-to-side anastomosis done using a circular stapler during colon tumor surgery at our institute between January 2015 and March 2019.

Results

Anastomotic bleeding developed in 10 (3.6%) of the total 279 patients. Univariate analysis revealed that age ≥ 80 years (8.8% vs. 1.9%; P = 0.008) and Eastern Cooperative Oncology Group performance status (ECOG PS) ≥ 1 (12.5% vs. 2.8%; P = 0.014) were significant risk factors for anastomotic bleeding. Postoperative anticoagulation therapy was not a risk factor for anastomotic bleeding. Multivariate analysis revealed that only age ≥ 80 years was an independent risk factor (odds ratio 4.12, 95% confidence interval 1.02–16.68, P = 0.047). Six of the ten patients with anastomotic bleeding were treated conservatively, three were treated by colonoscopic clipping, and one required surgery.

Conclusion

End-to-side anastomosis is safe and feasible, but must be performed carefully in the elderly, who are at higher risk of anastomotic bleeding.

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Funding

This research was supported by Grants-in-Aid for Scientific Research (C: Grant number; 17K10620, C: Grant number; 17K 10621, C: Grant number; 17K10623, C: Grant number; 18K07194, C: Grant number; 19K09114, C: Grant number; 19K09115) from Japan Society for the promotion of Science. This research was also supported by the Project for Cancer Research and Therapeutic Evolution (P-CREATE), grant number: JP19cm0106502 from the Japan Agency for Medical Research and Development (AMED).

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Tatsuki Noguchi, Shigenobu Emoto, Kazushige Kawai, Takeshi Nishikawa, Yasutaka Shuno, Kazuhito Sasaki, Manabu Kaneko, Koji Murono, Hiroaki Ishii, Hirofumi Sonoda, Toshiaki Tanaka, Keisuke Hata, Hiroaki Nozawa & Soichiro Ishihara

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  1. Tatsuki Noguchi
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  2. Shigenobu Emoto
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Correspondence to Tatsuki Noguchi.

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Noguchi, T., Emoto, S., Kawai, K. et al. Anastomotic bleeding following ileocolic end-to-side anastomosis using a circular stapler: incidence and risk factors. Surg Today 50, 1368–1374 (2020). https://doi.org/10.1007/s00595-020-02022-6

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  • DOI: https://doi.org/10.1007/s00595-020-02022-6

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