How Safe Are Laparoscopic Intracorporeal Anastomoses?

 

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Abstract

Background: A recent German Multicenter Study comprising 3 070 laparoscopic colorectal resections indicates that complete intracorporeal anastomoses are performed in only 1.8 % cases. The aim of our study was to review and analyse the safety of complete intracorpeal anastomosis. Methods: In a literature survey we searched for complete intracorporeal anastomosis with different key words. Results: In agreement with the literature, technically demanding hand-sutured anastomoses are no common practice. Intracorporeal anastomosis is usually done using endoscopic linear stapling devices or a conventional circular stapler by performing end-to-end, end-to-side, and side-to-side anastomoses. These techniques are more frequently used in the upper than in the lower gastrointestinal tract. Conclusions: The data published so far, however, indicates that completely intracorporeal performed anastomoses are safe in the hands of laparoscopically experienced surgeons. This technique implies very low percentages of postoperative stenoses (0-10 %) and, furthermore, very low percentages of postoperative anastomotic leakages (0-8 %).

Zusammenfassung

Grundlagen: Wie eine deutsche Multizenterstudie bei einer aktuellen Zwischenauswertung von 3 070 kolorektalen laparoskopischen Resektionen zeigt, werden vollständig intrakorporale Anastomosen mit 1,8 % nur selten hergestellt. Ziel der Studie ist, die Sicherheit vollständig intrakorporaler Anastomosen anhand der in der Literatur aufgezeigten Daten zu analysieren und darzustellen. Methodik: Es wurde eine aktuelle Literaturrecherche mit verschiedenen Suchwortkombinationen zur intrakorporalen Anastomosierung durchgeführt. Ergebnisse: Diese bestätigt, dass technisch anspruchsvolle Handnahtanastomosen, von wenigen Ausnahmen abgesehen, nur vereinzelt durchgeführt werden. Die intrakorporale Anastomosierung erfolgt in der Regel mittels endoskopischem Linearstapler oder konventioneller Zirkulärstapler in End-zu-End-, End-zu-Seit- und Seit-zu-Seit-Technik. Dabei werden diese instrumentellen Techniken häufiger am oberen als am unteren Gastrointestinaltrakt angewandt. Schlussfolgerungen: Aufgrund der publizierten Daten ist festzustellen, dass in den Händen laparoskopisch erfahrener Teams die intrakorporale Anastomosierung eine sichere Methode mit geringem Stenose- (0-10 %) und Insuffizienzrisiko (0-8 %) darstellt.

References

• 1 Ablaßmaier B, Gellert K, Tanzella U, Müller J M. Laparoscopic Billroth-II-gastrectomy.  J Laparoendosc Surg. 1996;  6 319-324
  PubMedGoogle Scholar
• 2 Azagra J S, De Simone P, Goergen M, Ibanez-Aguirre J. The Current Role of Laparoscopic Surgery in the Treatment of benign Gastroduodenal Diseases.  Eur J Coelio Surg. 1997;  1 41-46
  PubMedGoogle Scholar
• 3 Ballesta-Lopez C, Bastida-Vila X, Catarci M, Mato R, Ruggiero R. Laparoscopic Billroth II distal subtotal gastrectomy with gastric stump suspension for gastric malignancies.  Am J Surg. 1996;  171 289-292
  CrossrefPubMedGoogle Scholar
• 4 Bärlehner E. Erste Erfahrungen mit der laparoskopischen Magenresektion bei benignen und malignen Tumoren.  Zentralbl Chir. 1999;  124 346-350
  PubMedGoogle Scholar
• 5 Begos D G, Arsenault J, Ballantyne G H. Laparoscopic colon and rectal surgery at a VA hospital. Analysis of the first 50 cases.  Surg Endosc. 1996;  10 1050-1056
  CrossrefPubMedGoogle Scholar
• 6 Bergamaschi R, Arnaud J P. Immediately recognizable benefits and drawbacks after laparoscopic colon resection for benign disease.  Surg Endosc. 1997;  11 802-804
  CrossrefPubMedGoogle Scholar
• 7 Bergamaschi R, Marvik R, Thoresen J E, Ystgaard B, Johnsen G, Myrvold H E. Open Versus Laparoscopic Gastrojejunostomy for Palliation in Advanced Pancreatic Cancer.  Surg Laparosc Endosc. 1998;  8 92-96
  CrossrefPubMedGoogle Scholar
• 8 Böhm B, Milsom J W, Fazio V W. Laparoskopische Ileocoecalresektion beim M. Crohn.  Zentralbl Chir. 1994;  119 420-426
  PubMedGoogle Scholar
• 9 Böhm B, Milsom J W, Stolfi V M, Kitago K. Laparoscopic intraperitoneal intestinal anastomosis.  Surg Endosc. 1993;  7 194-196
  CrossrefPubMedGoogle Scholar
• 10 Brune I B, Feussner H, Neuhaus H, Classen M, Siewert J R. Laparoscopic gastrojejunostomy and endoscopic biliary stent placement for palliation of incurable gastric outlet obstruction with cholestasis.  Surg Endosc. 1997;  11 834-837
  CrossrefPubMedGoogle Scholar
• 11 Brune I B, Schönleben K. Laparoskopische Sigmaresektion.  Chirurg. 1992;  63 342-344
  PubMedGoogle Scholar
• 12 Cagigas J C, Martino E, Escalante C F, Ingelmo A, Estefania R, Gutierrez J M, Fleitas M G. Technical alternatives in laparoscopic distal gastric bypass for morbid obesity in a porcine model.  Obes Surg. 1999;  9 166-170
  CrossrefPubMedGoogle Scholar
• 13 Casaccia M, Diviacco P, Molinello P, Danovaro L, Casaccia M. Laparoscopic gastrojejunostomy in the palliation of pancreatic cancer: reflections on the preliminary results.  Surg Laparosc Endosc. 1998;  8 331-334
  CrossrefPubMedGoogle Scholar
• 14 Federmann G, Walenzyk J. Laparoskopische Ileotransversostomie.  Minim Invas Chir. 1993;  4 160-162
  PubMedGoogle Scholar
• 15 Fleshman J W, Brunt L M, Fry R D, Birnbaum E H, Simmang C L, Mazor A, Soper N, Freeman L, Kodner I J. Laparoscopic anterior resection of the rectum using a triple stapled intracorporeal anastomosis in the pig.  Surg Laparosc Endosc. 1993;  3 119-126
  PubMedGoogle Scholar
• 16 Fowler D L, White S A. Laparoscopic gastrectomy: five cases.  Surg Laparosc Endosc. 1996;  6 98-101
  CrossrefPubMedGoogle Scholar
• 17 Franklin M E, Ramos R, Rosenthal D, Schuessler W. Laparoscopic colonic procedures.  World J Surg. 1993;  17 51-56
  CrossrefPubMedGoogle Scholar
• 18 Gal I, Szivos J, Balint A, Hejjel L, Gyory I, Nagy B. Laparoscopic gastric surgery. Early experiences.  Acta Chir Hung. 1999;  38 163-165
  PubMedGoogle Scholar
• 19 Giraudo G, Kazemier G, Eijck C H Van, Bonjer H J. Endoscopic palliative treatment of advanced pancreatic cancer: thoracoscopic splanchnicectomy and laparoscopic gastrojejunostomy.  Ann Oncol. 1999;  10 (Suppl) 278-280
  CrossrefPubMedGoogle Scholar
• 20 Goh P M, Alponat A, Mak K, Kum C K. Early international results of laparoscopic gastrectomies.  Surg Endosc. 1997;  11 650-652
  CrossrefPubMedGoogle Scholar
• 21 Gurbuz A T, Watson D, Fenoglio M E. Laparoscopic choledochoduodenostomy.  Am Surg. 1999;  65 212-214
  PubMedGoogle Scholar
• 22 Guillou P J, Darzi A, Monson J RT. Experience with laparoscopic colorectal surgery for malignant disease.  Surg Oncol. 1993;  2 (Suppl 1) 43-49
  PubMedGoogle Scholar
• 23 Gutt C N, Riemer V, Kim Z G, Jacobi C A, Paolucci V, Lorenz M. Impact of laparoscopic colonic resection and tumour growth on spread in an experimental model.  Br J Surg. 1999;  86 1180-1184
  CrossrefPubMedGoogle Scholar
• 24 Higa K D, Boone K B, Ho T, Davies O G. Laparoscopic Roux-en-Y gastric bypass for morbid obesity: technique and preliminary results of our first 400 patients.  Arch Surg. 2000;  135 1029-1034
  CrossrefPubMedGoogle Scholar
• 25 Huscher C, Silecchia G, Croce E, Farello G A, Lezoche E, Morino M, Azzola M, Feliciotti F, Rosato P, Tarantini M, Basso N. Laparoscopic colorectal resection. A multicenter Italian study.  Surg Endosc. 1996;  10 875-879
  CrossrefPubMedGoogle Scholar
• 26 Jørgensen L S, Langkilde N C, Moller P K, Mortensen F V, Tei T M, Jacobsen N O. Aseptic laparoscopic colon resection with intraabdominal anastomosis. An experimental study in pigs.  Surg Endosc. 1998;  12 1245-1248
  CrossrefPubMedGoogle Scholar
• 27 Kleine U, Kraas E. Indikation zur laparoskopischen Dickdarmchirurgie.  Zentralbl Chir. 1995;  120 400-404
  PubMedGoogle Scholar
• 28 Köckerling F. et al .Multizenterstudie „Laparoskopische kolorektale Chirurgie”. Persönliche Mitteilung 2001
  Google Scholar
• 29 Köckerling F, Gastinger I, Schneider B, Krause W, Gall F P. Laparoskopische kolorektale Chirurgie: Kolon- und Rektumanastomosen in Triple-Stapling-Technique.  Minim Invas Chir. 1992;  1 44-50
  PubMedGoogle Scholar
• 30 Köckerling F, Schneider I, Schneider C, Hohenberger W. Laparoscopic intracorporeal anastomosis in the colon using the biofragmentable anastomotic ring - an animal study.  Int J Colorectal Dis. 1996;  11 299-302
  CrossrefPubMedGoogle Scholar
• 31 Lange V, Meyer G, Schardey H M, Gutschow C, Schildberg F W. Verschiedene Techniken für die laparoskopische Dünndarmanastomosierung. Eine vorläufige Mitteilung.  Chirurg. 1993;  64 408-411
  PubMedGoogle Scholar
• 32 Lange V, Meyer G, Schardey H M, Holker A, Lang R, Schildberg F W. Different techniques of laparoscopic end-to-end small bowel anastomosis.  Surg Endosc. 1995;  9 82-87
  PubMedGoogle Scholar
• 33 Lonitier P, Leroux S, Ferrier C, Dapoigny M. A technique of laparoscopic gastrectomy and Billroth II gastrojejunostomy.  J Laparoendosc Surg. 1993;  3 353-364
  PubMedGoogle Scholar
• 34 Machado M A, Herman P, Rocha J R, Machado M C. Primary intrahepatic lithiasis: report of a case treated by laparoscopic bilioenteric anastomosis.  Surg Laparosc Endosc Percutan Tech. 1999;  9 207-210
  CrossrefPubMedGoogle Scholar
• 35 Matthews B D, Sing R F, De Legge M H, Ponsky J L, Heniford B T. Initial Results with a Stapled Gastrojejunostomy for the Laparoscopic Isolated Roux-en-Y Gastric Bypass.  Am J Surg. 2000;  179 476-481
  CrossrefPubMedGoogle Scholar
• 36 Mayers T M, Orebaugh M G. Totally laparoscopic Billroth I gastrectomy.  J Am Coll Surg. 1998;  186 100-103
  CrossrefPubMedGoogle Scholar
• 37 Melotti G, Bonilauri S, Tamborrino E, Selmi I. Laparoscopic gastric resection.  Surg Endosc. 1994;  8 434
  PubMedGoogle Scholar
• 38 Ming Q, Yanming S, Chenzhu Z, Zhongwei K. Totally intra-abdominal laparoscopic Billroth II gastrectomy.  Surg Endosc. 1994;  8 434
  PubMedGoogle Scholar
• 39 Moriya H, Shimizu S, Okano T, Yamaguchi S. Experimental study of laparoscopic gastrectomy: intracorporeal Billroth I gastroduodenostomy.  Surg Laparosc Endosc. 1997;  7 32-37
  CrossrefPubMedGoogle Scholar
• 40 Nguyen N T, Ho H S, Palmer L S, Wolfe B M. Laparoscopic Roux-en-Y gastric bypass for super/super obesity.  Obes Surg. 1999;  9 403-406
  CrossrefPubMedGoogle Scholar
• 41 Olson K H, Balcos E G, Lowe M C, Bubrick M P. A comparative study of open, laparoscopic intracorporeal, and laparoscopic assisted low anterior resection and anastomosis in pigs.  Am Surg. 1995;  61 197-201
  PubMedGoogle Scholar
• 42 Phillips E H, Franklin M, Carroll B J, Fallas M J, Ramos R, Rosenthal D. Laparoscopic colectomy.  Ann Surg. 1992;  216 703-707
  CrossrefPubMedGoogle Scholar
• 43 Pietrafitta J J, Schultz L S, Graber J N, Hickok D F. An experimental technique of laparoscopic bowel resection and reanastomosis.  Surg Laparosc Endosc. 1992;  2 205-211
  PubMedGoogle Scholar
• 44 Potvin M, Gagner M, Pomp A. Laparoscopic Roux-en-Y gastric bypass for morbid obesity: a feasibility study in pigs.  Surg Laparosc Endosc. 1997;  7 294-297
  CrossrefPubMedGoogle Scholar
• 45 Reymond M A, Tannapfel A, Schneider C, Scheidbach H, Kover S, Jung A, Reck T, Lippert H, Köckerling F. Description of an intraperitoneal tumour xenograft survival model in the pig.  Eur J Surg Oncol. 2000;  26 393-397
  CrossrefPubMedGoogle Scholar
• 46 Rosenberg M H, Sultan M R, Bessler M, Treat M R. Laparoscopic harvesting of jejunal free flaps.  Ann Plast Surg. 1995;  34 250-254
  PubMedGoogle Scholar
• 47 Schneider I H, Schneider C, Thaler K, Reck T, Köckerling F. Intraperitoneal colon anastomosis with laparoscopic purse string suture clamp and Valtrac ring.  Langenbecks Arch Chir. 1994;  379 188-192
  CrossrefPubMedGoogle Scholar
• 48 Schauer P R, Ikramuddin S, Gourash W F. Laparoscopic Roux-en-Y gastric bypass: a case report at one-year follow-up.  J Laparoendosc Adv Surg Tech A. 1999;  9 101-106
  PubMedGoogle Scholar
• 49 Schüder G, Pistorius G, Plusczyk T, Hildebrandt U. Technik und Qualität laparoskopisch handgenähter Darmanastomosen im Experiment.  Zentralbl Chir. 1995;  120 409-414
  PubMedGoogle Scholar
• 50 Sharpe D R, Redwine D B. Laparoscopic segmental resection of the sigmoid and rectosigmoid colon for endometriosis.  Surg Laparosc Endosc. 1992;  2 120-124
  PubMedGoogle Scholar
• 51 Soper N J, Brunt L M, Fleshman J, Dunnegan D L, Clayman R V. Laparoscopic small bowel resection and anastomosis.  Surg Laparosc Endosc. 1993;  3 6-12
  PubMedGoogle Scholar
• 52 Taniguchi S, Koga K, Ibusuki K, Sugio K, Uchimura Y. Laparoscopic pylorus-preserving gastrectomy with intracorporeal hand-sewn anastomosis.  Surg Laparosc Endosc. 1997;  7 354-356
  CrossrefPubMedGoogle Scholar
• 53 Teixeira J A, Borao F J, Thomas T A, Cerabona T, Artuso D. An alternative technique for creating the gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass: experience with 28 consecutive patients.  Obes Surg. 2000;  10 240-244
  CrossrefPubMedGoogle Scholar
• 54 Tinoco R, El-Kadre L, Tinoco A. Laparoscopic Choledochoduodenostomy.  J Laparoendosc Adv Surg Tech A. 1999;  9 123-126
  PubMedGoogle Scholar
• 55 de la Torre R A, Scott J S. Laparoscopic Roux-en-Y gastric bypass: a totally intra-abdominal approach - technique and preliminary report.  Obes Surg. 1999;  9 492-498
  CrossrefPubMedGoogle Scholar
• 56 Watson D I, Devitt P G, Game P A. Laparoscopic Billroth II gastrectomy for early gastric cancer.  Br J Surg. 1995;  82 661-662
  PubMedGoogle Scholar
• 57 Wolharn R, Reuter F, Kenne R von, Clotten M, Szabo Z, Coburg A J. Laparoscopic Hand-Sewn Colon Anastomosis.  Surg Endosc. 1995;  9 242
  PubMedGoogle Scholar

Reinhold A. Lang

Chirurgische Klinik und Poliklinik · Klinikum Großhadern

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81377 München

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