COMPARISON OF COMPLICATIONS, OPERATING TIME AND COSTS IN DOUBLE-LAYERED HAND-SEWN VS. MECHANICAL STAPLED ILEO-ILEAL ANASTOMOSIS DURING RADICAL CYSTECTOMY

You have accessJournal of UrologyCME1 May 2022MP25-19 COMPARISON OF COMPLICATIONS, OPERATING TIME AND COSTS IN DOUBLE-LAYERED HAND-SEWN VS. MECHANICAL STAPLED ILEO-ILEAL ANASTOMOSIS DURING RADICAL CYSTECTOMY Gabriele Tulone, Nicola Pavan, Sofia Giannone, Giuseppe Alario, Alberto Abrate, Mirko Pinelli, Piero Mannone, Francesco Claps, Davide Baiamonte, Rosa Giaimo, Marco Vella, Carlo Pavone, Vincenzo Ficarra, and Alchiede Simonato Gabriele TuloneGabriele Tulone More articles by this author , Nicola PavanNicola Pavan More articles by this author , Sofia GiannoneSofia Giannone More articles by this author , Giuseppe AlarioGiuseppe Alario More articles by this author , Alberto AbrateAlberto Abrate More articles by this author , Mirko PinelliMirko Pinelli More articles by this author , Piero MannonePiero Mannone More articles by this author , Francesco ClapsFrancesco Claps More articles by this author , Davide BaiamonteDavide Baiamonte More articles by this author , Rosa GiaimoRosa Giaimo More articles by this author , Marco VellaMarco Vella More articles by this author , Carlo PavoneCarlo Pavone More articles by this author , Vincenzo FicarraVincenzo Ficarra More articles by this author , and Alchiede SimonatoAlchiede Simonato More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002568.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Intestinal anastomosis during radical cystectomy (RC), can be performed by hand suturing or by a mechanical suturing machine. The purpose of the study is to compare complications, timing and costs of the intestinal anastomosis techniques. METHODS: A multi-institutional cohort of 195 patients who underwent RC, performed by expert surgeons, from 2016 to 2021, were retrospectively analyzed. 100 (51.3%) double-layered hand-sewn intestinal anastomosis (HS-IA) with 2 Vicryl 3.0 and 2 Vicryl 4.0 stitches were performed. 95 (48.7%) mechanical stapled intestinal anastomosis (MS-IA) were conducted with a mechanical stapler (disposable Ethicon 75mm Linear Cutter from Johnson and Johnson) and 1 refill. RESULTS: Of the 195 procedures, 100 patients underwent HS-IA and 95 underwent MS-IA. The median age was 71 years (IQR 65-77 years). Charlson comorbidity index and ASA score were higher in the MS-IA group. 29 (29%) patients of the HS-IA group reported early postoperative complications and in 34 (36%) patients were documented in the MS-IA group (p<0.001). In the MS-IA group, 20 (21.1%) patients presented major complications according to Clavien Dindo, while only 6 patients (6%) had complications in the HS-IA group (p=0.03). In HS-IA group ileo-ileal anastomosis dehiscence occurred in 1 patient (1%); 1 patient (1%) had intestinal mechanical obstruction and 2 (2%) patients ileus in postoperative period. In the MS-IA group in 2 patients (2.1%) bowel perforation occurred, and intestinal obstruction in 2 patients was also reported. There is not a statistically difference in time to flatus and defecation, 2 days (IQR 2-3 days) vs 3 days (IQR 2-3 days) and 5 days (4-6 days) vs 5 days (4-6 days) respectively in the two groups. The median operating time for the hand-sewn anastomosis was 16.4 min (range 15.0-17.4 min), compared to 20.0 min (range 20.0 -20.0 min) p<0.001 for the mechanical suturing machine. The costs of the double-layered hand-sewn for a single patient is 5 €, against 350.00 € for a disposable mechanical stapler and one refill. CONCLUSIONS: Both HS-IA and MS-IA are safe and feasible without postoperative course differences but the HS-IA is less expensive and can reduce the operating time of the ileo-ileal anastomosis during RC. Additionally, MS-IA is reinforced with supplementary stitches and despite this, the risk of anastomosis dehiscence is not completely cancelled. Concluding, the HS-IA anastomosis is an important cost-saving approach compared to the stapled alternative. Source of Funding: No © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e436 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gabriele Tulone More articles by this author Nicola Pavan More articles by this author Sofia Giannone More articles by this author Giuseppe Alario More articles by this author Alberto Abrate More articles by this author Mirko Pinelli More articles by this author Piero Mannone More articles by this author Francesco Claps More articles by this author Davide Baiamonte More articles by this author Rosa Giaimo More articles by this author Marco Vella More articles by this author Carlo Pavone More articles by this author Vincenzo Ficarra More articles by this author Alchiede Simonato More articles by this author Expand All Advertisement PDF downloadLoading ...