eP520 - Safety of Staple Line Reinforcement of Intracorporeal Colorectal Anastomoses – a Pilot Study

Purpose/Background: While staple line reinforcement has been validated in the thoracic and gastric patient population, there is limited research investigating the safety and efficacy of a bioabsorbable staple line reinforcement in colorectal anastomoses. Given that anastomotic bleeding and leak are two major complications of any colorectal procedure with an anastomosis, our aim was to report rates of these serious complications in a pilot study.Methods/Interventions: This was a single-institution, single-surgeon retrospective case series of patients undergoing any robotic elective colorectal resection with an intestinal anastomosis with staple line reinforcement of the anastomosis between January 2023 and August 2023. For operations involving an EEA anastomosis, that anastomosis was not reinforced. However, the proximal and distal transection points for the colon were. For all other colectomies, the proximal and distal transection points as well as the common channel were all reinforced. The primary outcome was post-operative anastomotic GI bleed and anastomotic leak. Secondary outcomes included bright red blood per rectum (BRBPR) post-operatively, need for post-operative packed red blood cell (pRBC) transfusion, need for additional interventions for bleeding other than transfusion, 30-day overall morbidity, serious morbidity, anastomotic leak, readmission, reoperation, and length of stay (LOS).Results/Outcomes: A total of 28 patients were included with a median age of 58.5 years (Interquartile Range [IQR] 50.5, 71.5) (Table 1). 53.57% of patients were male and white. The series consisted of patients undergoing surgery for benign disease (39.29%), unresectable polyp(s) (32.14%), or known cancer (28.57%), all on the robotic platform with one unplanned conversion to open (3.57%). There were no instances of anastomotic GI bleed or anastomotic leak (Table 2). One patient required a post-operative pRBC transfusion (3.57%) and two patients had BRBPR within 48 hours post-operatively that resolved without intervention (7.14%). Rates for 30-day readmission and reoperation were 10.71% and 3.57%, respectively. Overall morbidity and serious morbidity were 14.29% and 7.14%, respectively. There were no mortalities within 30 days. Median LOS and operative time were 3 days (IQR 2.5, 3.5) and 210 minutes (IQR 153, 241).Conclusion/

Discussion: Staple line reinforcement of colorectal anastomoses is a novel technique not previously validated and demonstrated to be safe in this small case series. Larger, prospective studies are needed to further investigate outcomes of staple line reinforcement in comparison to standard anastomotic techniques, particularly on MIS platforms as intracorporeal anastomoses become more common."Table 1. Demographic, Clinical and Operative Characteristics

Table 2. 30 Day Post-Operative Outcomes
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