Bow tie technique for single stapled colorectal anastomosis: observational cohort study.

BACKGROUND

Single stapled anastomotic techniques have a growing interest in the field of colorectal surgery. This concept was developed to lower the leakage rate in colorectal anastomosis by avoiding cross stapling and eliminating dog ears. The bow tie technique is developed as an easier alternative to create a single stapled anastomosis because endoscopic suturing or transanal surgery is avoided.

METHODS

A retrospective analysis of prospective observed data was performed in a cohort of all patients who underwent surgery with a colorectal anastomosis between 01-01-2023 and 31-12-2024. Primary outcome parameters were technical feasibility and anastomotic leakage defined as any clinical, radiologic or intraoperative sign of anastomotic leakage. Completeness of linear stapler line resection in the anastomotic donut and air leak test were secondary outcome parameters.

RESULTS

Total of 184 patients with colorectal anastomosis were included. In 6 cases of TME the bow tie technique was not feasible. Anastomotic leakage occurred in 3.6% after sigmoidectomy, 0% after anterior resection with PME and in 9.6% after low anterior resection with TME. Linear stapler was completely resected in all cases and in 5 cases a positive air leak was reported.

CONCLUSION

The bow tie technique is technical feasible, facilitates a single stapled anastomosis and has promising results on anastomotic leakage in the high colorectal anastomosis. Limitation of the technique is a minimum length of the rectal stump.