APPLICATION OF LOCAL HEMOSTATIC AGENTS FOR STRENGTHENING THE SEAMS OF COLONIC ANASTOMOSES.

OBJECTIVE

The aim of this study was to evaluate the clinical outcomes of a combined technique using a three-row circular stapler and a collagen-fibrin patch (Tachocomb) for reinforcement of colonic anastomoses, with particular focus on the incidence of anastomotic leakage and early postoperative complications.

MATERIALS AND

METHODS

A retrospective cohort analysis included 272 patients who underwent colon or rectal resection with formation of a colonic anastomosis. The control group included 173 patients (63.6%) in whom anastomosis was formed using a conventional two-row circular stapler. The experimental group included 99 patients (36.4%) in whom a three-row circular stapler was used in combination with a collagen-fibrin patch (Tachocomb). The primary outcome was the incidence of anastomotic leakage. Relative risk, absolute risk reduction, number needed to treat, and statistical significance were calculated.

RESULTS

Anastomotic leakage occurred in 9 of 173 patients in the control group (5.2%) and in 3 of 99 patients in the experimental group (3.0%). The combined technique was associated with a lower absolute rate of leakage, with a relative risk of 0.58, an absolute risk reduction of 2.2%, and a number needed to treat of 46. However, the difference between the groups was not statistically significant (p=0.55), and the 95% confidence interval for relative risk was wide (0.16-2.10). These findings indicate a favorable clinical trend but do not allow confirmation of a statistically proven advantage.

CONCLUSIONS

The combined use of a three-row circular stapler and Tachocomb was associated with a lower observed rate of colonic anastomotic leakage compared with the conventional two-row stapling technique. Nevertheless, due to the retrospective design, limited sample size, and simultaneous introduction of both components, the independent contribution of the stapler configuration and the collagen-fibrin patch cannot be determined. Further prospective randomized studies are required to verify these findings.