Clinical surgery-International
Anastomotic leakage after laparoscopic resection of rectal cancer: The impact of fibrin glue

https://doi.org/10.1016/j.amjsurg.2009.01.018Get rights and content

Abstract

Background

The aim of this study was to evaluate whether the use of fibrin glue as a sealant over an anastomosis is a risk factor for anastomotic leakage after laparoscopic rectal cancer surgery.

Methods

Prospective data were collected from 223 patients with rectal cancer who underwent laparoscopic resection without defunctioning stoma.

Results

A total of 104 patients underwent laparoscopic rectal resection, followed by the application of fibrin glue over the stapled anastomosis, while 119 underwent surgery alone. No difference in clinically significant leakage was observed between the fibrin and the nonfibrin groups (5.8% vs 10.9%, P = .169). In multivariate analysis, extraperitoneal tumor location and operation duration >220 minutes were independently associated with anastomotic leakage.

Conclusions

Significant predictors of anastomotic leakage include extraperitoneal tumor location and operation length >220 minutes. Fibrin glue application over the stapled anastomosis was not found to be significantly associated with anastomotic leakage.

Section snippets

Methods

A prospectively maintained, practice-specific institutional database was analyzed for all laparoscopic resections for rectal cancer performed between May 6, 2005, and July 14, 2008, at Chonnam National University Hwasun Hospital. All operations were performed by the same surgeon (H.R.K.); May 6, 2005, was selected as the starting point for the analysis because H.R.K. had performed 100 laparoscopic colectomies by May 3, 2005, which we deemed a “learning period.” A total of 282 patients underwent

Results

The characteristics of patients in the fibrin and nonfibrin groups are shown in Table 1. The 2 groups were well matched with respect to patient characteristics, with the exception of a shorter mean operating time (P = .001) and a later time of surgery (P < .000) of patients in the fibrin group (Table 1). A total of 47 patients received preoperative chemoradiation therapy during the analysis period; 36 were excluded because they underwent coloanal anastomosis with protective stoma. The

Comments

Laparoscopic colon surgery was first reported in 1991 by Jacobs et al19 and Fowler and White.20 Hundreds of reports have followed, detailing experiences with laparoscopic rectal resection and documenting equivalent disease-specific outcomes.1, 2, 3, 4 Anastomotic leakage remains an important issue for any surgeon undertaking rectal resection. The reported incidence of clinical leakage after laparoscopic surgery for rectal cancer varies from 6% to 17%.1, 2, 3, 4, 5 Many important data were

References (37)

  • F. Marusch et al.

    Value of a protective stoma in low anterior resections for rectal cancer

    Dis Colon Rectum

    (2002)
  • N. Dehni et al.

    Influence of a defunctioning stoma on leakage rates after low colorectal anastomosis and colonic J pouch-anal anastomosis

    Br J Surg

    (1998)
  • K.C. Peeters et al.

    Risk factors for anastomotic failure after total mesorectal excision of rectal cancer

    Br J Surg

    (2005)
  • J. Folkesson et al.

    The circular stapling device as a risk factor for anastomotic leakage

    Colorectal Dis

    (2004)
  • G. Bonanomi et al.

    Sealing effect of fibrin glue on the healing of gastrointestinal anastomoses: implications for the endoscopic treatment of leaks

    Surg Endosc

    (2004)
  • A. Akgun et al.

    Early effects of fibrin sealant on colonic anastomosis in rats: an experimental and case-control study

    Tech Coloproctol

    (2006)
  • K.A. Haukipuro et al.

    Sutureless colon anastomosis with fibrin glue in the rat

    Dis Colon Rectum

    (1988)
  • A. Hjortrup et al.

    Rectal anastomosis with application of luminal fibrin adhesive in the rectum of dogsAn experimental study

    Dis Colon Rectum

    (1989)
    • View full text
    Copyright © 2010 Elsevier Inc. All rights reserved.