Influence of stapler size used at ileal pouch-anal anastomosis on anastomotic leak, stricture, long-term functional outcomes, and quality of life

Am J Surg. 2010 Jul;200(1):68-72. doi: 10.1016/j.amjsurg.2009.06.036.

Abstract

Background: The aim of this study was to evaluate whether stapler size used at ileal pouch-anal anastomosis (IPAA) influences outcomes.

Methods: Data of patients undergoing stapled IPAA (1983-2007) were obtained. Differences between groups A (stapler size 28-29 mm) and B (31-33 mm) for pre- and perioperative factors, stricture, leak, quality of life (QOL), and function were compared. Associations between stapler size and stricture or leak were assessed with a multivariable Cox model.

Results: Groups A (n = 1,221) and B (n = 899) had comparable age, diagnosis, body mass index (BMI), and albumin level. Group B had more males (P < .001) but fewer patients with ileostomy (P < .001). There was no significant difference in rates of leak (4.5% vs 6.2%, P = .08) or stricture (1.9% vs 2.7%, P = .1) for groups A and B. On multivariate analysis, female gender was associated with stricture, while greater BMI and male gender were associated with leak. Group A had greater urgency at 1 year and nighttime pad use at 15 years. The other determinants of function and QOL were similar.

Conclusions: There was no significant association between the size of stapler used at IPAA and long-term complications.

MeSH terms

  • Adult
  • Cohort Studies
  • Colonic Diseases / complications
  • Colonic Diseases / pathology
  • Colonic Diseases / surgery*
  • Colonic Pouches / adverse effects*
  • Constriction, Pathologic / epidemiology
  • Equipment Design
  • Female
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications*
  • Quality of Life*
  • Recovery of Function
  • Retrospective Studies
  • Surgical Staplers*
  • Surgical Stapling*
  • Treatment Outcome