Purpose: Evaluate the impact of extracellular matrix on bowel anastomotic complications.
Background: The incidence of anastomotic leak is 1-33%. It remains the most feared colorectal surgical complication leading to sepsis and death. Anastomotic leaks alter bowel function and overall cancer survival.
Methods: We retrospectively reviewed a single surgeon’s experience at our VAMC. From January 1, 2012 to December 1, 2014, 50 patients had bowel anastomoses performed without reinforcement. Due to complications, we began using extracellular matrix as reinforcement for all bowel anastomoses. From October 31, 2014 to May 19, 2017, 66 reinforced bowel anastomoses were performed.
Results: 50 anastomoses were completed in the first 23 months. 12 ileostomy reversals/small bowel anastomoses were completed without leaks. 12 ileo-colonic anastomoses resulted in 1 abscess requiring interventional radiology drainage for several months, which ultimately healed. 13 left-sided anastomoses were completed without complication. 13 low anterior anastomoses were performed: 2 leaks resulted in 2 patients after chemoradiation despite fecal diversion. 1 resulted in a complete stenosis and remains diverted. The second underwent revision with colo-anal pull through and resulted in complete stenosis requiring completion APR. Neither returned to bowel continuity.
After bowel reinforcement was begun, 66 bowel anastomoses were completed in 31 months. 9 ileostomy reversal/small bowel anastomoses were completed, without leaks. 33 ileo-colonic anastomoses resulted without leaks. 9 left-sided anastomoses were completed resulting in 2 leaks: both were suture repaired and had fecal diversion. Neither resulted in stenosis. 1 has returned to bowel continuity and the other is pending. 9 Low anterior anastomoses were performed: 3 leaks resulted in 3 patients. 1 required completion APR due to low location. The remaining 2 were
treated with drainage and fecal diversion. However, both healed without stenosis and were restored to bowel continuity.
Conclusions: Many new technologies have been investigated to reduce anastomotic complications. None have proven to work effectively. In our experience, extracellular matrix as reinforcement agent showed a trend in limiting the severity of the anastomotic leak and furthermore appears to limit progression to stenosis and affords return to bowel continuity: improving surgical quality outcomes.
