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Validation of an endoscopic anastomotic grading score as an intraoperative method for assessing stapled rectal anastomoses

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Abstract

Purpose

Anastomotic leak is a dreaded complication of colorectal surgery. An endoscopic grading score of the perianastomotic mucosa has been previously developed at our institution (UCI) to assess colorectal anastomotic integrity. The objective of this study is to validate the UCI anastomotic score and determine its impact in anastomotic failure.

Methods

As a follow-up study of the UCI grading score implementation during 2011 to 2014, patients undergoing stapled colorectal anastomoses after sigmoidectomy or proctectomy at a single institution from 2015 to 2018 were retrospectively reviewed. Patients were grouped into three tiers based on endoscopic appearance (grade 1, circumferentially normal mucosa; grade 2, ischemia/congestion < 30% of circumference; grade 3, ischemia/congestion > 30% of circumference).

Results

On the basis of endoscopic mucosal evaluation, grade 1 anastomosis was observed in 299 patients (94%), grade 2 anastomosis in 14 patients (4.4%), and grade 3 anastomosis in 5 patients (1.6%). All grade 3 classifications were immediately and successfully revised intraoperatively with reclassification as a grade 1 anastomosis. The anastomotic leak rate of the follow-up study period from 2015 to 2018 was 6.4% which was lower compared to the anastomotic leak rate of 12.2% in the original study period from 2011 to 2014 (p = 0.07). Anastomotic leak rate for the entire patient series was 8.5%. A grade 2 anastomosis was associated with higher anastomotic leak rate compared to a grade 1 anastomosis (35.7% vs. 7.4%, p < 0.05). None of the five grade 3 anastomoses resulted in an anastomotic leak upon revision.

Conclusion

This study further validates the anastomotic grading score and suggests that its systematic implementation can result in a reduction in anastomotic leaks.

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Data Availability

The empirical data referred to in this paper are available on request from the corresponding author, but are not public due to privacy restrictions, as they were acquired from medical records after IRB review.

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Department of Surgery, University of California, Irvine, Orange, CA, USA

    C. Farzaneh, W. Q. Duong, J. C. Carmichael, S. D. Mills & M. J. Stamos

  2. Division of Surgery, Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    A. Uppal

  3. Department of Surgery, New York Presbyterian Hospital Weill Cornell College of Medicine, 525 E 68th Street, NY, New York, USA

    M. D. Jafari & A. Pigazzi

Authors
  1. C. Farzaneh
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  2. A. Uppal
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  3. M. D. Jafari
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  4. W. Q. Duong
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  5. J. C. Carmichael
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  6. S. D. Mills
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  7. M. J. Stamos
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  8. A. Pigazzi
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Corresponding author

Correspondence to A. Pigazzi.

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Conflict of interest

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Dr. Cyrus Farzaneh, Dr. Abhineet Uppal, Dr. William Duong, and Dr. Michael Stamos have no conflicts of interest or financial ties for disclosure. Dr. Mehraneh Jafari has received honorarium as a speaker for Covidien. Dr. Joseph Carmichael has received honorarium as a speaker for Medtronic and Johnson & Johnson. Dr. Steven Mills has received honorarium as a speaker for Medtronic. Dr. Alessio Pigazzi has received honorarium as a consultant for Medtronic, Vioptix, Ethicon, and Intuitive.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Farzaneh, C., Uppal, A., Jafari, M.D. et al. Validation of an endoscopic anastomotic grading score as an intraoperative method for assessing stapled rectal anastomoses. Tech Coloproctol 27, 1235–1242 (2023). https://doi.org/10.1007/s10151-023-02797-z

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  • DOI: https://doi.org/10.1007/s10151-023-02797-z

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