EP607 - Ileocolic anastomosis with 100 mm stapler. Does it have advantages?

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Purpose/Background: Anastomotic dehiscence is the most feared complication of colorectal surgery. Despite advances, it is still not clear which ileocolic anastomosis is better. An observational study by the European Society of Coloproctology in 2015 shows a rate of dehiscence in mechanical ileocolic anastomosis of 8.5% and 7.4% in manual anastomosis, even questioning the mechanical technique. The most commonly used mechanical technique is the laterolateral one using a 75 mm linear stapler, which often requires adding a new load to close the apical enterotomy . A recent retrospective study by the group of Wexner et al. demonstrated for the first time that stapler size is an independent factor for lower anastomotic complications.
In our group, we have used a 100 mm linear stapler in all laterolateral ileocolic anastomosis since 2014 while noticing with time that more frecuently we needed more tan one firing to close the apical enterotomy and that trying to fire only one stapler 75 resulted in some cases that there were no staplers in the tissue in both extremes of the firing zone.
There are no series that describe the exclusive use of this type of stapler for ileocolic anastomosis.

Methods/Interventions: A retrospective review is made of a registry of elective ileocolic anastomoses in which side-to-side anastomosis was performed with a 100 mm stapler consecutively from January 2014 to April 2024 at Clínica Alemana in Santiago.
Demographic data, anastomotic complications, and number of stapler loads used are analyzed.

Results/Outcomes: 65 patients were recruited. The median age was 66 years (21-93). 51% were men and 49% women. 95% of the patients were operated on for cancer.
All had albuminemia over 3.0 g/dl. All surgeries were laparoscopic and the anastomoses were extracorporeal.
There was 1 anastomotic dehiscence (1.59%) in a patient with significant weight loss and one case of internal hernia, both managed surgically.
No patient needed more than 1 load for the apical enterotomy closure.
There was no postoperative bleeding requiring any intervention.
There was no mortality in the series.

Conclusion/Discussion: The use of a 100 linear stapler to create side-to-side ileocolic mechanical anastomoses presented a low rate of dehiscence in our series.
Using only 1 load for the apical enterotomy closure could influence this result, also offering an economic advantage by not requiring a second load.