Comparison study stapled versus hand sewn method for large bowel anastomosis surgery
Author(s): Dr. Mishaan Khalel Ismael and Dr. Amir Hinbis Masawod Al-Azzawi
Abstract:Background: Intestinal anastomosis is one of the most commonly performed procedure it required to re-establish gastrointestinal continuity after surgical resection, traumatic disruption or bypass procedures. In last decade, advances in intestinal stapling devices have led to an increased frequency of stapled anastomosis. There are a variety of proposed benefit from a stapled technique: better blood supply, reduced tissue manipulation, less oedema, uniformity of suture, adequate or perhaps wider, lumen at the site of anastomosis, ease and rapidity.
Objectives: To compare the relative safety and effectiveness of stapled anastomosis with that of hand sewn anastomosis for large bowel surgery.
Patients & Methods: A prospective study was conducted on 103 patients who suffered from benign and malignant disease in addition to trauma patients. They were divided into two groups (SA) group which involved (51) patients where the anastomosis were done by stapler and other group of (52) patients where the anastomosis were done by hand sewing named as (HS) group. All elective cases were prepared for surgery preoperatively by mechanical and chemical preparation while patients in emergency situation had the full criteria for primary anastomosis. Both groups had the same preoperative characters such as age and sex, and the types of outcome analyzed were specific mortality, clinical anastomotic leak, stricture, anastomotic haemorrhage, re-operation, wound infection, anastomotic duration and hospital stay.
Results: A total of 9 patients (17.6%) in SA group developed complications compared to 20 patients (38.5%) in H.S group (P. value >0.019). Nine patient developed fistula in HS group (17.3%) compared to two patients (3.9%) in SA group (P. value > 0.035). Mean postoperative hospitalization time for SA group (6.5) days while for HS group (8.8) days (P. value 0.75). There is a significant difference regarding fistula in favours of stapled anastomosis.
Conclusions: Staples anastomosis is safe and effective and associated with fewer leak than hand sewn anastomosis.