Aim: The anastomosis technique used following right-sided colonic resection is widely variable and may affect patient outcome. This study aimed to assess the association between leak and anastomosis technique (stapled vs handsewn). Method: This was a prospective, multicentre, international audit including patients undergoing elective or emergency right hemicolectomy or ileo-caecal resection operations over a 2-month period in early 2015. The primary outcome measure was the presence of anastomotic leak within 30Â days of surgery, determined using a prespecified definition. Mixed effects logistic regression models were used to assess the association between leak and anastomosis method, adjusting for patient, disease and operative cofactors, with centre included as a random-effect variable. Results: This study included 3208 patients, of whom 78.4% (nÂ =Â 2515) underwent surgery for malignancy and 11.7% (nÂ =Â 375) underwent surgery for Crohn's disease. An anastomosis was performed in 94.8% (nÂ =Â 3041) of patients, which was handsewn in 38.9% (nÂ =Â 1183) and stapled in 61.1% (nÂ =Â 1858). Patients undergoing handsewn anastomosis were more likely to be emergency admissions (20.5% handsewn vs 12.9% stapled) and to undergo open surgery (54.7% handsewn vs 36.6% stapled). The overall anastomotic leak rate was 8.1% (245/3041), which was similar following handsewn (7.4%) and stapled (8.5%) techniques (PÂ =Â 0.3). After adjustment for cofactors, the odds of a leak were higher for stapled anastomosis (adjusted ORÂ =Â 1.43; 95% CI: 1.04â1.95; PÂ =Â 0.03). Conclusion: Despite being used in lower-risk patients, stapled anastomosis was associated with an increased anastomotic leak rate in this observational study. Further research is needed to define patient groups in whom a stapled anastomosis is safe.
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