Results of the multicenter study (A.C.O.I. Stapler Study Group) on 420 cases of esophagojejunal and 544 cases of colorectal anastomoses

The introduction of staplers in general surgery allowed to perform gastrointestinal anastomoses easier and with better results. Because many series report an important incidence of complications even using stapling instruments, the A.C.O.I. (Italian Association of General Hospital Surgeons), with the support of Auto Suture Italy, promoted a collaborative trial in Italy to evaluate the real incidence of complications after stapled colorectal or esophago-jejunal anastomoses. The study has been carried out during the period April 1990-December 1991 and 58 Centres throughout Italy participated with 420 esophagojejunostomies after Total Gastrectomy and 544 Colorectal anastomoses after Anterior Resection of the Rectum. Many variables were evaluated such as patients general conditions, the pathology and the site of anastomosis, the instrument used, the technique of reconstruction, if it was an urgent or an elective procedure, the incidence of intraoperative problems and the surgical experience. The most frequent complications were bleeding, leakage and stenosis. The incidence of bleeding was low in both groups, it was an occasional event not related with any of the variables previously described. Furthermore it was never important and never required reoperation or caused death of the patient. Leakage was the most frequent and serious complication (12.4% in colorectal anastomoses and 5.5% in esophagojejunostomies) and was mainly related to the incidence of intraoperative technical problems (tearing of the stump or purse string failure), to urgent procedures, to low and ultra low colorectal anastomoses and to centres with less experience, particularly with an experience of less than 50 mechanical anastomoses. Late complications such stenoses, were particularly frequent (8.4%) after a leakage and in very low colorectal anastomoses. Perioperative Mortality was very low in birth groups (1.1% for colorectal anastomoses and 2.6% for esophagojejunostomies) one of the lowest described in the Literature. This study seem to confirm that staplers are effective, safe and easy to use, showing a low incidence of complications and they make possible anastomoses otherwise technically impossible.