HAnd Suture Versus STApling for Closure of Loop Ileostomy (HASTA Trial): results of a multicenter randomized trial (DRKS00000040).

OBJECTIVES: The objective of the HASTA trial was to compare hand suture versus stapling loop ileostomy closure in a randomized controlled trial. BACKGROUND: Bowel obstruction is one of the main and the clinically and economically most relevant complication following closure of loop ileostomy after low anterior resection. The best surgical technique for closure of loop ileostomy has not been defined yet. METHODS: HASTA trial is a multicenter pragmatic randomized controlled surgical trial with 2 parallel groups to compare hand suture versus stapling for closure of loop ileostomy. The primary endpoint was the rate of bowel obstruction within 30 days after ileostomy closure. RESULTS: A total of 337 randomized patients undergoing closure of loop ileostomy after low anterior resection because of rectal cancer in 27 centers were included. The overall rate of postoperative ileus after ileostomy closure was 13.4%. Seventeen of 165 (10.3%) patients in the stapler group and 27 of 163 (16.6%) in the hand suture group developed bowel obstruction within 30 days postoperatively [odds ratio (OR) = 1.72; 95% confidence interval (CI): 0.89-3.31 = 0.10]. Duration of surgical intervention was significantly shorter in the stapler group (15 minutes; P < 0.001). Multivariable analysis of potential risk factors did not reveal any significant correlation with development of postoperative ileus. Rate of anastomotic leakage (stapler: 3.0%, hand suture: 1.8%, P = 0.48) did not differ significantly as well as all other secondary endpoints. CONCLUSIONS: Hand-sewn anastomosis versus stapler ileo-ileostomy for ileostomy closure are equally effective in terms of postoperative bowel obstruction, with stapler anastomosis leading to a shorter operation time. Postoperative ileus after ileostomy reversal remains a relevant complication.

Endotension is influenced by aneurysm volume: experimental findings.

PURPOSE: To investigate in an in vitro model whether and to what extent pressure is influenced by aneurysm size. METHODS: Latex aneurysms of 3 different volumes (24, 30, and 81 mL) were inserted into an in vitro circulation model. The systemic mean pressure (SP(mean)) was varied from 50 to 120 mmHg. The aneurysms were excluded using a woven polyethylene graft. Aneurysm sac mean pressure (ASP(mean)) was measured. RESULTS: In the in vitro model, endovascular aneurysm repair created a closed chamber without endoleak but showed a relevant aneurysm sac pressure. At an SP(mean) of 80 mmHg, the ASP(mean) was 42.0+/-0.6 mmHg in the 24-mL aneurysm, 40.5+/-0.5 mmHg in the 30-mL model, and 19.3+/-0.5 mmHg in the 81-mL aneurysm (p<0.05). The ASP(mean) rose with increasing SP(mean) and was inversely dependent on the aneurysm volume. CONCLUSIONS: This in vitro model demonstrated that the sac mean pressure correlated to the systemic pressure and that a greater aneurysm volume reduced aneurysm sac pressure. These data highlight the need for further studies regarding endotension.