EPD203 - Postoperative Intraluminal Bleeding Rates By Anastomotic Staple Height In Right Sided Colon Resection

ePoster of Distinction Presenter(s)

• 

  Arielle Brackett, MD (she/her/hers)

  Colon and Rectal Surgery Fellow
  Baylor University Medical Center
  Baylor University Medical Center
  Dallas, TX, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Author(s)

• ZQ

  Zeena Qiryaqoz, MD

  Resident physician
  Baylor University Medical Center
  Dallas, Texas, United States

  Disclosure information not submitted.
• AH

  Abdul Hassan, MD, MAS

  Colon and Rectal Surgery Fellow
  Baylor University Medical Center
  Dallas, Texas, United States

  Disclosure information not submitted.
• 

  Loree Beth Thornton, MD

  Colorectal Surgery Fellow PGY 6
  Baylor University Medical Center
  Baylor University Medical Center
  Dallas, TX, United States

  Disclosure information not submitted.
• GO

  Gerald Ogola, PhD

  Biostatistician
  Baylor Scott & White Health
  Dallas, Texas, United States

  Disclosure information not submitted.
• AW

  Anthony Waddimba, PhD

  Research Investigator
  Baylor University Medical Center
  Dallas, Texas, United States

  Disclosure information not submitted.
• 

  Sarah Stringfield, MD (she/her/hers)

  Attending
  Baylor University Medical Center
  Texas A&M College of Medicine
  Dallas, TX, United States

  Disclosure information not submitted.
• WL

  Warren Lichliter, MD

  Surgeon
  Baylor Scott & White Health
  dallas, Texas, United States

  Disclosure information not submitted.
• 

  James W. Fleshman, Jr., MD

  Surgeon
  Baylor Scott & White Health
  Dallas, Texas, United States

  Disclosure information not submitted.
• 

  Katerina O.K Wells, MD MPH (she/her/hers)

  Chief, Division of Colon and Rectal Surgery, Baylor University Medical Center, Dallas
  Baylor University Medical Center, Dallas
  Baylor University Medical Center, Dallas
  Dallas, TX, United States

  Disclosure information not submitted.

Senior Author(s)

• ZR

  Zachary Roberts, MD

  Staff Surgeon
  Baylor University Medical Center
  Dallas, Texas, United States

  Disclosure information not submitted.

Purpose/Background: Anastomotic bleeding following right hemicolectomy with stapled ileocolic anastomosis is an infrequent but potentially serious complication. Severity of bleeding ranges from mild hematochezia to severe hemorrhage necessitating blood transfusion, endoscopic intervention, or reoperation with anastomotic revision. A variety of stapling devices and staple heights are routinely employed in the construction of stapled ileocolic anastomoses. However, there remains no clear consensus on whether these technical variations influence postoperative outcomes. In this retrospective cohort study, we aim to assess the association between stapler height and anastomotic bleeding, 30-day morbidity, and 30-day readmission following stapled ileocolic anastomosis in patients undergoing right hemicolectomy.

Methods/Interventions: A single-center retrospective cohort study was performed evaluating patients undergoing right and extended right hemicolectomy with stapled anastomosis performed between January 2020 and April 2025. All surgeries were performed by fellowship-trained colorectal surgeons. Multivariable logistic regression was used to assess the effect of staple height on anastomotic bleeding, requirement for reintervention, 30-day morbidity, and 30-day readmission.

Results/Outcomes: A total of 365 patients were studied (193 female [52.9%], mean age 62.2 years). Preoperative anticoagulation use and/or antiplatelet use were noted in 8% and 31.3% of patients respectively. There were 33 open (9%), 161 laparoscopic (44.1%), and 171 robotic (46.9%) procedures. Anastomotic construction was intracorporeal in 143 cases (39.3%) and extracorporeal in 221 cases (60.7%). White cartridge (stapler height 2.6 mm) was used in 70 (19%), blue cartridge (stapler height 3.6 mm) was used in 270 (74%), and green cartridge (stapler height 4.6 mm) was used in 25 (7%) patients. Post-operative anastomotic bleeding rate was 9%, with bleeding managed conservatively in 97% of patients with hemodynamic monitoring (60.6%) or blood transfusion (36.3%). Lower endoscopic evaluation was required in one patient (3%). Anastomotic leak rate was 0.8%. Adjusted odds of 30-day anastomotic bleeding was 62% lower for staple height of 3.6 mm versus 2.6 mm (OR 0.38, 95% CI 0.17-0.89; p = 0.022). Staple height did not significantly affect 30-day reintervention, 30-day morbidity, or 30-day readmission.

Conclusion/Discussion: Use of a 3.6 mm staple height was an independent protective factor against 30-day anastomotic bleeding. When anastomotic bleeding occurred, reintervention was seldom required with spontaneous resolution of bleeding noted in all cases. Staple height used for anastomotic construction did not significantly affect other postoperative outcomes. Further investigation with large-scale and randomized patient populations is warranted to validate these findings.

Table 1
Adjusted logistic regression models for effect of staple height on 30-day anastomotic bleeding outcome